OBJECTIVES/HYPOTHESIS: The purpose of this study was to analyze the anatomical and audiologic results in pediatric Type I cartilage tympanoplasties with primary intubation. Our hypothesis was that the outcome of patients with tubes placed would be similar to those without tubes, even though the ears that received tubes were in worse condition. STUDY DESIGN: Retrospective chart review of patients undergoing cartilage tympanoplasty with intubation between 2007 and 2012. METHODS: All surgeries were performed or supervised by the senior author as the surgeon, using a modification of the perichondrium/cartilage island flap. All patients had a tube placed through the cartilage to allow for middle ear aeration. Hearing results were reported using a four-frequency (500, 1,000, 2,000, 3,000 Hz) pure-tone average and a pure-tone average air-bone gap (PTA-ABG). Postoperative complications were recorded. RESULTS: During the study period, cartilage with intubation was used for tympanic membrane reconstruction in 20 patients. Of these, 10 (50.0%) had craniofacial abnormalities, and the remainder had documented Eustachian tube dysfunction with mucoid effusion present at the time of surgery. The average patient age was 8 years, and the average follow-up was 39 months. The average pre- and postoperative PTA-ABGs were 25.1 ± 11.2 dB (standard deviation, SD) and 15.1 ± 10.2 dB (p < 0.05), respectively, and the average pre- and postoperative PTAs were 36.6 ± 12.4 and 24.9 ± 12.0 dB (p < 0.05), respectively. Only one case had to undergo revision, which was a result of a cholesteatoma. Of the 20 patients, 15 still had patent tubes at last follow-up, three had their tubes removed, and two had tube extrusion. CONCLUSIONS: Cartilage tympanoplasty with intubation achieves good anatomical and audiologic results when Eustachian tube dysfunction or craniofacial abnormalities are present. Significant hearing improvement was realized in a patient population that is characteristically more prone to problems.