OBJECTIVE To evaluate the choice of microsurgical treatment modalities and it's clinical effect on middle ear cholesteatoma and chronic suppurative otitis media. METHODS 110 cases with middle ear cholesteatoma and chronic suppurative otitis media were analysed which performed canal wall up mastoidectomy and canal wall down mastoidotympanectomy or at the same time tympanoplasty depending on lesion extent and the recovery time, complications, recurrence and postoperative hearing improvement were followed-up. RESULTS 110 cases were reviewed including 66 cases of middle ear cholesteatoma, 44 cases of chronic suppurative otitis media. Among these 51 cases undergone canal wall up mastoidotympanectomy accounting for 46.36%, 46 case undergone tympanoplasty, accounting for 41.81%. 59 cases undergone canal wall down mastoidectomy, accounting for 53.64%. In the canal wall up mastoidectomy group, 37 ears got hearing improvement >25 dB(33.64%), >15 dB 14 ears(12.72%), while in the canal wall down mastoidectomygroup, 5 ears got hearing improvement>15 dB(4.55%), 4 ears hearing loss(3.64%). Statistically significant difference exist in preoperative and postoperative speech frequency of average hearing threshold. We have found 4 cases of recurrence with cholesteatoma after 1 year follow-up. CONCLUSION According to different lesions of middle ear and mastoid, different operative methods can be used to obtain the corresponding clinical curative effect.