<p>Chronic Otitis Media (COM) is often perceived as a unilateral disease; however, growing evidence suggests contralateral ear involvement even in asymptomatic patients. This study aims to evaluate the structural and functional status of the contralateral ear in cases of unilateral COM. A cross-sectional observational study was conducted over 18 months on 160 patients aged 10–60 years, diagnosed with unilateral COM (mucosal or squamosal type) at a tertiary care center. Patients underwent detailed clinical examination, otoscopic and otoendoscopic evaluation, Pure Tone Audiometry, and radiological assessment (X-ray mastoid Schuller’s view). Among the 160 patients, 68.1% had mucosal and 31.9% had squamosal COM. Abnormalities in the contralateral ear were observed in 104 patients (65%), despite being clinically asymptomatic. Common findings included tympanic membrane retraction (43.1%), conductive hearing loss (55.6%), and diploic changes on radiology (46.3%). A significant number of patients with unilateral COM exhibit early structural or functional changes in the contralateral ear. These findings underscore the necessity of comprehensive bilateral ear evaluation in all COM cases, regardless of symptoms, to facilitate early intervention and prevent disease progression.</p>