Background <p>Successful myringoplasty depends on several factors, including adequate middle ear ventilation and pressure regulation. Mastoid pneumatization is an important anatomical feature that reflects the status of the middle ear–mastoid system and contributes to maintaining middle ear homeostasis. Different mastoid types (pneumatic, diploic, mixed, and sclerotic) have been proposed to influence graft healing and surgical outcomes. However, the effect of mastoid pneumatization on myringoplasty success remains controversial.</p> Aim <p>This study aimed to detect the impact of mastoid type in predicting the outcome of endoscopic myringoplasty operation success.</p> Subjects and methods <p>Between January 2024 and January 2025, 30 patients attended in the otorhinolaryngology department at Sohag University Hospital participated in this retrospective study. Cases diagnosed with CSOM, medium-sized central tympanic membrane perforations, underwent CT scan for mastoid information, including pneumatization, and underwent endoscopic myringoplasty with tragal composite perichondrial and cartilage graft.</p> Results <p>All patients diagnosed with conductive hearing loss with air-bone gap 23.16 ± 7.1dB underwent endoscopic myringoplasty with tragal composite perichondrial and cartilage graft, resulting in a 90% success rate for graft taking and 10% failure graft taking. Utilizing a CT scan, we were able to determine that 13 patients (43.3%) had sclerotic mastoid, 10 patients (33.3%) had pneumatic mastoid, 4 patients (13.3%) had mixed mastoid while 3 patients (10%) had diploic mastoid. No significant relationship between type of mastoid and graft uptake (P-value = 0.75), Also no significant relationship between type of mastoid and outcome of hearing regarding ABG gain (P-value = 0.51).</p> Conclusion <p>There is no significant relationship between type of mastoid and success of myringoplasty.</p>