Evaluate the surgical treatment of tympanic membrane (TM) retractions with modified cartilage augmentation tympanoplasty. Retrospective review of subjects with Charachon stage II and III TM retractions who underwent modified cartilage augmentation tympanoplasty following excision of the retracted TM segment. Pre and postoperative symptoms and air-bone gaps were recorded. Forty two ears were included in the study. Twenty six ears were of stage II and 16 were stage III retractions. 35 (83 %) ears had ossicular erosion and cholesteatoma was found in 13 (31 %) ears, all in stage III retractions. Follow-up ranged 12-102 months. The air-bone gap (ABG) improved in 29 (76 %) and worsened in seven (19 %). Ears without cholesteatoma had a greater improvement in ABG. The results of our modified cartilage tympanoplasty technique are comparable to the published literature and should provide a safe and acceptable result. The high rate of cholesteatoma found preoperatively in stage III retractions advocates early surgical intervention.