We report our experience with island cartilage tympanoplasty in revision cases and assess the anatomical and functional outcomes. We conducted a retrospective chart review at a tertiary referral center for patients who underwent revision tympanoplasty using cartilage with the island technique without mastoidectomy between January 2002 and December 2008. 60 cases were included in the study and successful closure without reperforation was obtained in 52 of 60 patients (87%). Three failed cases underwent a subsequent procedure endaurally with a positive result (92% accumulated success rate). Average postoperative pure-tone audiometry air-bone gap was 13 ± 7 dB compared with 21 ± 11 dB preoperatively (p = 0.004). An overall postoperative air-bone gap of 20 dB or less was achieved in 46 of the 60 patients (76.7%). Tympanoplasty with island cartilage grafting is a reliable procedure for revision cases with excellent anatomic results as well as significant improvement of hearing.