Both inside-out mastoidectomy and outside-in mastoidectomy techniques are established for treating chronic middle ear disease, but they differ in their extent of disease clearance, technical demand, and preservation of healthy structures. While Inside-out mastoidectomy is more targeted, often preserving more healthy bone and soft tissue, potentially resulting in improved post-operative cosmesis, on the other hand, Outside-in mastoidectomy provides systematic and extensive disease clearance, which may, however, result in greater changes to post-operative ear anatomy, which could negatively impact cosmesis. Assessment of pain, hearing improvement, and disease control are central to understanding the overall benefit of each method, but quality of life and patient satisfaction incorporating cosmesis are often underreported in literature comparing these techniques. By evaluating these outcomes side-by-side, we may highlight the need for considering both clinical objectives and patient-perceived benefits when planning a mastoidectomy surgery, paving the way for a more holistic treatment of chronic middle ear disease