In recent years teaching middle ear surgery techniques may have taken a back seat to other subspecialties. This course covers the preoperative selection of proper cases, the surgical anatomy and techniques as well as the postoperative care. It includes the basic as well as the sophisticated pearls to deal with CSF leak, semicircular canal fistula, sigmoid sinus damage, facial nerve injury, canal stenosis and meatal collapse. A must for residents and attendings who have yet to acquire a wealth of experience.