Chronic middle ear infection is highly prevalent in our country. Retraction pockets elude early detection due to lack of overt symptomatology. The exact etiology of development of retraction pockets is still unknown. But it is certain that faulty middle ear aeration is the primary cause for this clinical entity. This paper is aimed to study the effectiveness of tragal cartilage perichondrial composite autograft in the management of posterosuperior retraction pockets of pars tensa of the tympanic membrane and also to study the predisposing factors responsible for the development of retraction pockets. Eighty-nine ears of 56 patients with retraction of pars tensa were studied. There were 30 males and 26 females; age varies from 6 to 45 with an average of 20 years. Most of the patients in this study had mild or moderate hearing loss. Very few had a severe conductive hearing loss or sensory neural hearing loss. The severity of hearing loss does not bear any relation to the stage of the retraction of the tympanic membrane. Very severe retraction may be associated with mild hearing loss and vice versa. Similarly, the presence or absence of ossicular necrosis does not make any difference in the degree of hearing loss. Out of this 56 patients, 29 underwent surgical management. Twenty-two out of this 29 patients had ossicular necrosis. Twenty-five patients had no recurrence of retraction after the surgery. Even though four patients developed retraction that was only around the cartilage graft and there were no pocket formations, and the retraction was not directly in contact with the ossicles. There was no graft failure as such; that means graft take up was 100 percent. So the study suggested early surgical intervention with cartilage perichondrial composite grafting is a successful technique for management of posterosuperior retraction pockets of pars tensa to safeguard hearing and to prevent possible cholesteatoma formation later.