Chronic suppurative otitis media is a common ear disease, and its surgical treatment requires an individualized plan based on the patient’s specific situation. This chapter reviews the selection of surgical incisions and approaches, the choice of surgical methods, and key surgical techniques. It focuses on issues related to the anatomical structures of the middle ear and associated functional disorders, with a focus on the assessment methods for dysfunction of the tympanic cavity ventilation system and the ventilation conditions of the mastoid and the upper tympanic cavity. In addition, it discusses the principles for managing anatomical abnormalities of the middle ear and related diseases, postoperative factors affecting hearing, methods for cartilage reconstruction of the tympanic membrane, and the issue of tympanosclerosis. By comparing different treatment approaches and surgical techniques, this chapter emphasizes their impact on hearing and patient outcomes.