This month’s journal issue discussed global health in otolaryngology with this paper focusing on the management of chronic middle ear disease in the developing world. Chronic suppurative otitis media (CSOM) is more common in developing countries. The reason for this is believed to be multifactorial, including crowded living conditions, tobacco smoking, inadequate antibiotic treatment and limited access to medical care. Interestingly, the prevalence of CSOM is not solely explained by the socioeconomic status of a particular country with heterogeneity seen even among countries with similar socioeconomic status. There is limited data in the literature to report on the complication rate of CSOM in developing countries, but the authors found some evidence that showed mastoiditis secondary to CSOM is higher. The WHO estimate 90% and 50% of CSOM patients in Africa and South East Asia respectively do not have access to an ENT surgeon. Mobile clinics have been set up to improve access to treatment and projects have been developed to improve sustainability of the services by training local providers and improving patient education. Patients requiring mastoid surgery are treated with canal wall down approach as they would not be seen on a regular basis and presumed to be noncompliant for further follow-up. Hearing loss treatment is limited as well, as hearing aids are very expensive without the support of non-profit organisations. In summary, a lot of work is being done to improve treatment of middle ear disease in developing countries with the aim of not only improving access to treatment, but also ensuring sustainability of the service by regular training of local healthcare workers, but more could be done.