Transmeatal exploratory tympanotomy has been used traditionally for the surgical treatment of conductive deafness. With 8 cases of the middle and inner ear diseases diagnosed and surgical managed successfully with this approach, the extended applications of this procedure were illustrated, which included: 1. conductive deafness with cause undetermined, 2. post traumatic conductive deafness with intact tympanic membrane, 3. suspected primary space occupying lesion of tympanum. 4. perilymphatic fistula, and 5. cerebrospinal fluid otorrhea. The key consideration and advantage of this approach were also discussed in this paper.