There are many different ways to treat complex chronic middle ear disease, with ongoing advancements being made globally. Diverse approaches are necessitated for variations in patient age, degree of infection, extent of middle ear remodeling, inflammation severity, and underlying mechanisms of Eustachian tube dysfunction. Addressing multinational and clinical nuances, the editors have compiled 48 chapters with eclectic perspectives from otology experts in 13 countries. The surgical anatomy of the middle ear cleft and mastoid and underlying pathophysiological mechanisms of chronic otitis media are clinically challenging. Articles cover anatomy, physiology, disease characterizations and manifestations, clinical evaluation, office management, surgical procedures, and new horizons. Traditional and newer hybrid techniques for systematic disease and inflammatory conditions are presented in roundtable format, for example, underlay fascia tympanoplasty as well as the use of cartilage and bioengineered materials.Selected Key Topics: Applied middle ear anatomy and physiologyPathologic mechanisms of chronic otitis media Office evaluation, management and surgical decision makingMastoid cavity obliteration and canal wall reconstructionChallenges in tympanoplasty and ossicular chain reconstructionTraditional and hybrid tympanomastoid surgeryHearing implants in the chronic earThis is an exceptional teaching tool for ear surgeons in training as well as a must-have clinical resource for practicing otolaryngologists.