The ideal goals of chronic middle ear surgery should be the permanent removal of disease and the preservation of good hearing function. The postoperative outcome of hearing and the status of middle ear after canal wall-down tympanoplasty with primary ossiculoplasty were studied in 192 ears with chronic middle ear disease. Cholesteatoma was present in 121 (63.0%) of 192 cases; in the remaining 71 cases (27.0%), there was middle ear mucosa disease without cholesteatoma. The stapes superstructure was present in 142 (73.9%) of 192 cases. The results of preoperative and postoperative pure-tone averages were 55.12 (SD, 4.92) and 35.81 (SD, 4.84) dB, respectively. The preoperative and postoperative air-bone gaps in 192 cases were 32.70 (SD, 5.18) and 21.16 (SD, 5.09) dB, respectively. The mean hearing gain of the 192 ears was 19.17 (SD, 6.09) dB. The presence of stapes superstructure positively affects hearing status. Also, better hearing results were obtained in cholesteatoma cases presented. Recurrences of disease were seen rarely compared with literature. It was revealed that the postoperative outcome of primary canal wall-down tympanoplasty with ossicular chain reconstruction is suitable for safe ear and hearing ear.