Anaesthesia for ear surgery requires knowledge of the relevant anatomy and appreciation of the principal surgical requirements – a stationary patient and dry operating field intraoperatively to facilitate surgery; and, smooth emergence from anaesthesia at the end of surgery, to minimize complications. To achieve the optimum patient outcome, the anaesthetist must modify their anaesthetic technique, tailoring it to the individual patient and the underlying pathology, including employing intraoperative strategies to safely manipulate the patient's blood pressure and preserve facial nerve function, techniques to attenuate airway reflexes at emergence, and utilizing a multimodal approach to provision of analgesia and postoperative nausea and vomiting prophylaxis. Crucially, the anaesthetist must be aware that many surgical procedures involving the ear are undertaken to preserve, improve or restore hearing function, such that careful preparation and meticulous perioperative care are essential in order to optimize outcome and to minimize complications.