Introduction <p>Chronic otitis media (COM) is a prevalent condition that often necessitates surgicalmanagement when conservative therapy fails. The SAMEO-ATO classification offers acomprehensive system for documenting surgical details. This study evaluates thesurgical outcome of COM surgery based on SAMEO-ATO classification.</p> Materials and Methods <p>This prospective observational study was conducted among 100 patients with COMundergoing tympanoplasty, tympano-mastoid surgery at a tertiary care centre inWestern India over 18 months. Intraoperative procedure, findings were recorded usingthe SAMEO-ATO classification. Surgical outcomes were assessed through pre- andpostoperative pure-tone audiometry, focusing on air-bone gap (ABG) closure and graftuptake. Statistical analysis was performed using SPSS v21.0.</p> Results <p>Most cases involved mucosal COM (88%), with 88% undergoing primary surgery (S1).Endaural transcanal access (A1) 67% and surgeries without mastoidectomy (Mx) 75%were predominant. Significant postoperative ABG improvement was noted (meanreduction: 10.5 dB, p &lt; 0.001). Superior outcomes were associated with A1 approaches and ossicular chain preservation (On). Temporalis fascia, used in 84% oftympanoplasty cases, showed a lower residual perforation rate.</p> Conclusion <p>SAMEO-ATO provides a comprehensive way to document operative details andcorrelate them with hearing outcomes.</p>