Introduction <p>Contralateral ear (CLE) is defined as an asymptomatic ear in cases of unilateral Chronic Otitis Media (COM). The continuum theory of the pathogenesis of COM depicts various pathological stages but of the same disease, and this evolution concept of the continuum theory could be even detected in the CLE. The current study aims to analyse otoscopic, radiological, and audiological status of CLE in series of patients with unilateral COM in both mucosal and squamous types. And develop a risk index score to evaluate the CLE.</p> Materials and Methods <p>A Cross-sectional study was carried out on 46 patients of unilateral COM in both mucosal and squamous types. The CLE was evaluated and a COM risk index score was developed based on the otoscopic, audiological and radiological parameters.</p> Results <p>All the patients 23(100%) cases of mucosal COM and 22(100%) cases of squamous COM were grouped as low (0–5), intermediate (6–10) and high-risk categories (11–16). In mucosal COM, maximum number of patients; 10(43.5%) were at low risk followed by 7(30.5%) cases at intermediate risk whereas in squamosal COM, maximum number of patients; 17(37.8%) were at high risk followed by 13(28.8%) cases at intermediate risk.</p> Conclusion <p>On grading the patients according to the COM risk index score, based on the above parameters we conclude beyond doubt that patients with squamosal COM were at a higher risk of developing COM in the supposedly normal contralateral ear.</p>