Clinical observations of surgical management of anomalies of the external and middle ear were carried out in 30 ear cases for the last 12 years from 1974 to 1986. 1) Sex distribution was 14 cases(53.8%) in male, and 10 cases(46.2%) in female. 2) The anomalies were 21 cases of atresia auris externa(70%), 4 cases of stenosis of external auditory canal(13.3%) with remaining 5 cases(16.7%) of normal external auditory cannal. 3) The distribution of the lesion in 21 cases of atresia auris externa showed 6 cases(28.6%) of left side only. 4) Age distribution was from 3 year to 46 years old and the majority was preschool age with 18 cases. 5) The relationship between ossicular anomaly and auriculo-maxillo-facial anomaly was seen in 8 cases with Treacher Collins syndrome, and in cases with normal maxillo-facial structures, monofocal type was 4 cases(13.3%). 6) Ossicular anomaly was most commonly incudostapedial separation, 12 cases(40%) and others were incudomalleal fixation with 6 cases(20%) ; incudostapedial separation and stapes fixation, 5 cases(16.6%) ; stapes fixation, 3 cases(10%) ; incudomalleal fixation and incudostapedial separation, 2 cases(6.7%) ; and total ossicular defect in 2 cases(6.7%). 7) The shapes of ossicular defect were nail type(36.2%) ; leaf type(21.4%) ; block type(18.6%) ; incudomalleal head type(12.8%) ; and incudomalleal handle type(11%). 8) The classification of auricular defects were 8 cases with loaf ear and among them, lob ear, 3 cases(37.5%) were most common, all others showed single case of protruding ear, flaring ear, folded ear, burried ear, and macacus ear. 9) The follow-up of postoperative hearing improvement in 12 cases which was possible for 6 months to 7 years, based on the observation with mean value of air conduction in speech range showed 26.7% dB in atresia auris with ossicular anomaly compared to preoperation, 15.4 dB in middle ear anomaly only, and 15.3 dB in stapes fixation with fused ossicles. No hearing change and with rather decreased hearing was seen in one case each and the decreased hearing was seen in severly defected vestibular window reconstruction. 10) Among the 4 surgical methods, canaloplasty, tympanoplasty, stapes surgery and fenestration of lateral semicircular canal, the tympanoplasty and stapes surgery which reconstructed the natural conductive system was used whenever possible. 11) The object of the surgery in atresia auris externa was the formation of external auditory canal and tympanic cavity. Furthermore, external auditory canal drilling was done by one tunnel approach, in which tympanic cavity and attic was reached by drilling anteriorly on the circle with 6-8 mm in diameter at the inner margin of the angle formed between the line connecting lower orbital margin and protuberantia occipitalis externa on the Reid's base line and temporomandibular fossa. Canaloplasty was done by free skin graft which tympanoplasty procedure was applied for tympanic cavity and ossicular defect. To avoid facial nerve injury, atresia bony plate must be drilled carefully with surgical attention, and diamond bur was at slow speed of 80-200 CPS. The apex of the deformed incus was confirmed before preceeding with the surgery to avoid damage which might occur due to the anomalous course of the facial nerve.