Chronic otitis media is mostly caused by the perforation left over from acute otitis media in early childhood, which repeatedly drains pus and causes hearing loss, bringing great pain to the patient’s life. Most of the chronic otitis media can temporarily control the inflammation by antibiotic treatment, but the condition is recurrent and some cause granulomatous hyperplasia because of the leftover tympanic membrane perforation, therefore, chronic otitis media cannot be treated fundamentally with antibiotics alone. The toxins released by the bacteria destroy the nerve cells in the inner ear, leading to sensorineural deafness. Also, because of the perforation of the tympanic membrane and the destruction of the auditory bone, the patient’s hearing decreases significantly and progressively worsens with the recurrent inflammation. Even if you do not want to improve your hearing through surgery, to prevent further hearing loss, it is still recommended that patients with otitis media have early surgery to remove the inflammatory lesion and repair the tympanic membrane perforation. Patients who normally have very little pus flow should have their tympanic membrane perforations repaired as soon as possible, not only to regain the natural barrier of the tympanic membrane for middle ear protection and eliminate recurrence of otitis media, but also to gain hearing improvement. For patients with frequent pus flow, or with middle ear cholesteatoma, the lesions in the middle ear and mastoid must be removed, and the tympanic membrane must be repaired and the hearing reconstructed at the same time, which we call tympanoplasty. In the past, for otitis media and middle ear cholesteatoma that persisted, the method of mastoid radical surgery was used, but this procedure did not repair the tympanic membrane perforation and did not perform hearing reconstruction, and has been gradually phased out. Tympanoplasty, currently performed, is the basic procedure of modern ear microsurgery. Under a high-powered microscope, the subtle lesions in the mastoid process of the middle ear are completely removed, and the auditory chain is reconstructed and the tympanic membrane perforation is repaired. Because of the complete removal of the lesion and the reconstruction of the tympanic chamber and hearing, the majority of patients no longer have pus after surgery, and most patients have good hearing, and if they have tinnitus, most of it can be reduced or disappeared. Moreover, with modern ear microsurgery techniques, surgery can be performed even if the patient is bleeding pus, ending the past history of patients with recurrent pus not being able to undergo surgery. Current surgical methods are improving year by year, allowing the surgeon to remove the lesion and reconstruct the middle ear in a minimally invasive manner. The scar is barely visible and the ear canal and tympanic membrane are close to normal after surgery. The author also performs endoscopic otolaryngoscopic surgery, which is much less invasive and results in a faster recovery.