I have noticed that there are often questions online from patients about cholesteatoma in the middle ear, one of which is whether to operate for cholesteatoma. I have made it very clear in my article “Cholesteatoma – a time bomb in the ear” that if it is not done in time, I am afraid that small problems will turn into big problems, most commonly pus flow and hearing loss, and in severe cases, facial paralysis and intracranial infection. Therefore, once cholesteatoma is detected, it must be operated as soon as possible. Cholesteatoma-type otitis media, a common inflammatory disease of the middle ear, is operated on in large and small hospitals, with varying postoperative results. Poor postoperative results, such as recurrence, pus flow, and poor hearing recovery, are partly due to the severity of the disease itself before surgery, partly because the lesions were not cleaned up during surgery, and partly because the disease was not reviewed regularly after surgery. In most cases, the middle ear cholesteatoma can be completely removed in one operation, but in the case of temporal bone cholesteatoma, because of its deep location, large scope, and difficulty in surgery, it sometimes cannot be removed in one operation and may recur after surgery. If the cholesteatoma is not cleaned up, it will definitely bleed after surgery, but the bleeding does not necessarily mean recurrence. In open tympanoplasty, the ear cavity is relatively large, so regular follow-up is necessary to clean up the scab (skin debris, metabolic products, etc.); otherwise, moisture and water in the ear are very likely to cause bacterial growth and infection. What is also more important is the experience of the surgeon. There is less post-operative pus and recurrence after surgery done by a good otolaryngologist. The chance of facial palsy caused by surgery is about one percent, depending on the condition and the level of experience of the surgeon. If the facial nerve is damaged during surgery, facial palsy will be visible after surgery. Sometimes the facial nerve is irritated and inflamed and swollen due to the complete removal of the cholesteatoma, and facial palsy may also occur, but it can be recovered. There is another type of facial palsy, called “delayed facial palsy”, which is not directly related to surgery, but is caused by postoperative lowered resistance and viral infection, and appears 1 week to 10 days after surgery.