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The attending anesthesiologist face several challenges in safe conduction of anesthesia for middle ear and cochlear implantation surgeries. Preoperative challenges includes counseling elderly patients with impaired hearing and counseling the parents of children with congenital ear anomalies, thorough evaluation of these patient with several comorbidities. Intraoperative challenges are to provide bloodless field, head positioning, effect of nitrous oxide on middle ear, facial nerve monitoring and avoid electrical disturbances due to electrocautery during stimulation of the cochlear implant electrode assembly. Postoperative challenges includes smooth and calm recovery, prevention and treatment of postoperative nausea and vomiting (PONV) and excellent analgesia. A close understanding and cooperation between the anesthesiologist and surgeon is the key for a positive outcome. How to cite this article Madan HK, Kosare S. Anesthesia for Middle Ear Surgeries and Cochlear Implant. Int J Otorhinolaryngol Clin 2015;7(1):1-9.