The nose and paranasal sinuses by their situation are the cause of most ear diseases. Diagnosis and treatment of nasal condition is important for successful treatment of the ear pathology. Proper evaluation of the nasal and sinus condition in relation to the ear pathology can avoid many unnecessary nasal and otological surgeries. Patience in trying out conservative treatment before suggesting surgery is a necessary virtue. Very often, chronic otitis media with effusion (COME) is a sequelae of acute otitis media particularly in a child who persists in sniffing resulting in thick fluid obstructing the eustachian tube (ET) preventing ventilation of the middle ear. 70% of middle ear effusions can be traced to URTI. Untreated, it may also result in sequelae that form the basis of many ear pathologies and there are many questions in its management that are unanswered. The article discusses the author’s views in management of ear diseases. As otologists, our primary aim is resolution of ear pathology and successful outcome in cases of surgical intervention. Very often, overlooking the basic pathology in the nose or sinus may result in compromising these results.