Learning Objectives: To teach all of the factors that increase the risk of complications of surgery to the temporal bone.

This presentation is based on the importance of the development of good and safe technique in the surgical management of patients with temporal bone disease in order to minimise the risk of complications. An outline of the principles of surgery in chronic suppurative otitis media is followed by a demonstration of the anatomy of the temporal bone by comparing a coronal cadaveric section with the corresponding coronal CT scan. The importance of temporal bone dissection, supervision and training, high resolution imaging and facial nerve monitoring in helping to avoid complications is discussed.

The careful auditing of the surgeon's own results and their utilisation in obtaining informed consent, intellectual honesty and the ability to know when not operate are then presented. The reasons for failure to obtain a dry ear, the unsatisfactory mastoid cavity and sites where bone removal may be inadequate are considered. The preoperative discussion with the patient and the risk of specific complications and how to avoid them are outlined. Finally newer techniques such as the use of the laser and endoscopy are discussed in relation to reducing risk.