Ear microsurgery is based on microanatomy of the ear and temporal bone, high-resolution imaging of the ear and temporal bone for diagnosis and microsurgical techniques. Ear microsurgery focuses on the study of microscopic application of anatomy, surgical access and reconstruction of functional structures of the ear. Traditional otologic surgery is represented by mastoid radical surgery, which is mainly used to remove lesions, promote drainage, and prevent intracranial and extracranial complications. Although it can effectively prevent and treat intracranial and extracranial complications, the success rate of tympanic membrane repair and reconstruction of the auditory chain is low due to incomplete clearance of the lesion and inadequate exposure of the tympanic chamber structure, and postoperative pus still often flows from the ear. Considering from the perspective of hearing, traditional mastoid radical surgery is difficult to improve hearing, and in practice the chance of hearing reduction is greater than that of hearing improvement. In contrast, microsurgery of the ear emphasizes the functional reconstruction of hearing along with complete removal of the lesion. The vestibular nerve, cochlear nerve and facial nerve in the inner ear canal as well as the inner ear structures are deeply buried in the temporal bone, and their spatial three-dimensional location is an obstacle difficult to cross in traditional otologic surgery. The facial nerve has 27mm buried in the temporal bone, and without familiarity with the anatomy of the facial nerve, damage to the facial nerve can easily occur during surgery. The development of modern ear microsurgery and the resulting extension of ear neurosurgery is based on microscopic applied anatomical studies of the temporal bone conducted by otologic clinicians, combined with imaging studies, which allow precise preoperative spatial positioning of the microscopic structures of the ear and enable planned and precise surgery for ear deformities, inflammation, tumors, and trauma. 1.Basic requirements for ear microsurgery: equipment: high-performance operating microscope, high-speed microscopic ear drill, artificial auditory bone, bipolar electrocoagulation, fibrinogen adhesive, etc. 2.Papillary contouring techniques and identification of microscopic structures during surgery to completely remove the lesion, establish new drainage channels, and reduce complications. 3. Restoration of middle ear auditory function, including: reconstruction of the auditory chain, reconstruction of the air-containing cavity of the middle ear mastoid, artificial middle ear, cochlear implantation, and auditory brainstem implantation. 4. The main components of otolaryngology: facial nerve and trigeminal nerve surgery, vertigo surgery, auditory neuroma surgery, and temporal bone related lateral skull base tumor surgery. Ear microsurgery and ear neurosurgery are developed from traditional ear surgery, which is a great leap in the history of ear surgery. The advent of high-performance surgical microscopes, high-resolution CT and MRI, and the application of navigation technology have led to the further development of otomicrosurgery and otoneurosurgery by integrating with skull base surgery, head and neck surgery.