Patients suffering from chronic otitis media often have a variety of associated disease processes and pathologic conditions. These conditions and processes range from cholesteatoma to eustachian tube dysfunction. The identification and recognition of the factors contributing to the disease process of chronic otitis media are critical to the effective treatment of the condition. Familiarization with conditions associated with chronic otitis media, the disease process, and the guidelines for surgical therapy is also essential. Furthermore, this surgical therapy is designed to provide surgeons with a technique that allows sequential assessment of the pathologic and anatomic variables in the disease process, thus allowing the use of only those conservative surgical steps necessary in each case.