Surgeons should select and perform tympanomastoid procedures based on the pathogenesis of the disease and the needs of the patient. The patient should be positioned correctly. Steps should not be skipped. Surgeons should consider meatoplasty and canalplasty (when applicable) as an integral part of the procedure. Anatomic closures should be performed, and deepithelized areas should not be left. If necessary, skin grafting should be used. Attention to detail should be used. Details make a big difference; however, a big difference is no detail. Tympanomastoid surgery is intended to eradicate the disease process and to help in the regression of middle ear histopathologic changes. Based on the principles of pathogenesis, surgery is aimed at interfering in the pathologic process to stop the continuum of disease and to reestablish function with the proper timing. The ultimate goal is to treat patients with otitis media medically, reserving surgery for the restoration of function rather than for the eradication of disease.