Mastering the techniques of mastoidectomy and understanding their principles constitute one of the primary tasks in the curriculum of otolaryngology residency. The learning curve is steep, but for the otologists, it is fundamental for their understanding of the temporal bone and look beyond. Even a lifetime seems too short to unravel the intricacies of the related surgical principles. No wonder why the age-old debate on the better technique of mastoidectomy in an unsafe ear—canal wall-up (CWU) or -down (CWD)—continues to perplex generations of otologists [1]. This is a hereditary knowledge trait, refined and updated with every successor, and each time opens up fresh discussions whether the debate would, if ever, have any unanimous solution.
The challenges before the new-age otologists are many. To decide and adopt a technique unbiased and situation-based is often beyond one’s capacity in the beginning of his or her surgical career, and it is fine-tuned by complex, unpredictable interactions of multiple factors. It starts with the mother institution and the “school of thought” it brews. Their influences might not always be co-existing, but mostly they are. Further, an interesting observation as it might be, the space allotted for “chronic otitis media (COM), its complications and management” within the broad section of “otology, neurotology, and skull-base surgery” is getting limited as the mentor textbooks, arguably the most authentic sources of documented information and evidence, proudly enter into their latest editions. Within a decade, it has reduced by 10.7% in Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery (the 6th, excluding the volume on adult audiology, and 7th editions). The same has increased by 8.94% in Cummings Otolaryngology—Head and Neck Surgery over two decades (the 3rd and 6th editions), but it is against an overall increase by 14.3% of the broad section. Evidently, contemporary otology is fast changing its face, incorporating broadened scope and applications on neurotology, skull-base surgery, related recent advances, and rehabilitation and quality of life (QOL) measures. Should this trend imply that COM as a disease is becoming “smaller”? Is there a decrease in patient load, reduced clinical significance, or both? Or, is it a matter of shifting priority and relevance, with good reasons, of course?