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To provide a state of the art review on accruing studies focused on defining the middle ear microbiome, highlighting the relationship of the microbiome to disease pathophysiology. Pubmed indexed peer-reviewed articles and published textbooks. Comprehensive review of the literature using the following search terms "microbiome" "bacterial pathogens" with the term "otitis media," and "middle ear." A multitude of microbiome studies have been published in the recent past. In general findings from these studies underscore distinct profiles ba