The first three priorities in surgery for chronic otitis media are (1) the elimination of progressive disease to produce a safe and dry ear, (2) modification of the anatomy of the tympanomastoid compartment to prevent recurrent disease, and (3) reconstruction of the hearing mechanism. The indications for revision following mastoidectomy for chronic otitis media thus involve failure to achieve any of these goals, including recurrent cholesteatoma, recurrent suppuration, recurrent perforation, or recurrent or residual conductive hearing loss. The focus of this article is the management of recurrent cholesteatoma or suppuration; that is, failure to achieve either of the first two priorities.