Type of study: a prospective study. Objective: To evaluate the effectiveness of Endoscopic Inlay Butterfly Cartilage Myringoplasty by assessing the take rate and hearing gain. Background: Since the introduction of tympanoplasty, various graft material and methods have been described to close central dry perforation of the tympanic membrane (TM).Cartilage graft represents one of the most commonly used materials.To avoid postauricular incision, Eavey introduced the Inlay Butterfly Cartilage Myringoplasty as a minimally invasive technique in children with small central perforations. Patients and Methods: 25 patients with dry central perforation and Air-Bone Gap (ABG) of ≤ 30dB were operated by the Endoscopic Inlay Butterfly cartilage Myringoplasty between 2013-2016. All patients had small to medium sized perforations with inactive mucosal disease. The Follow-up period ranged from 1 to 14 months. All patients were assessed clinically to evaluate healing of TM, discharge, granulation tissues and complications. Postoperative ABG was used as the key parameter for hearing evaluation by calculating the average Pure Tone Audiometry (PTA) improvement. Results: A total of 25 patients were involved in this study; 14 males (56%) and 11 females (44%). The graft was taken in 19 patients that represent success rate (76%); this rate was comparable with other many studies in the literature. Preoperative mean (±SD) of ABG was 22.4 (±6.14), While postoperative mean (±SD) of ABG was 14.8 (±10.2) with statistically significant difference (P < 0.001). Conclusions: Inlay Butterfly Myringoplasty is a simple technique for repair of small to medium-sized TMs perforation with good results. It carries many advantages over the usual conventional methods of tympanoplasty.