One issue I've noticed is in organisations that have staff in regions that don't have title inflation. For example in the UK orgs I've worked the majority of people were not particularly concerned about titles and didn't even put titles in their email sigs. When some offshore temp contractors came onsite and gave themselves grandiose titles in their email sigs that were far above the people they reported to it created a lot of confusion and consternation.

I've also seen issues when UK colleagues who are senior enough to manage teams who manage teams, but are still below the "Director" role, then have to manage an entire team of "Directors" and "VPs" in NA who are the bottom rung and manage nobody. It seems like the job titles in NA can be totally meaningless? I suppose if you are used to how it works, it works fine, but if you are from a region with more conservative (and accurate?) titles it causes friction due to an imbalance in perceived power dynamic.

I've even seen an org chart in a NA firm that has 3 CTOs stretching down the same reporting line, which just seems pointless.