There has been a considerable expansion in the use of tympano-ossicular homografts in the past decade. The use of homograft tympanic membranes and homograft ossicles as well as combined tympano-ossicular homografts has been shown to be effective in reconstructive surgery for chronic otitis media. While homograft tympanic membranes are effective in the repair of perforations, temporalis fascia is at least as effective and more readily available. Therefore, the unique benefit of the tympano-malleal homograft (TMH) is that it is an effective way of replacing the malleus, the "building block" for reconstruction of the ossicular chain. The indications and techniques for the use of the TMH are presented and illustrated through representative cases. The inclusion of the TMH in the otologist's armamentarium offers another avenue for reconstruction of the chronically diseased ear.