Many patients think that otitis media through simple drug treatment is enough, this is actually the otitis media treatment misunderstanding. Medication can only temporarily relieve the localized infectious inflammation of otitis media; for the anatomical damage already caused by otitis media (e.g., perforation of the eardrum, destruction of the auditory ossicles, bone defects, etc.) as well as the deeper foci (e.g., cholesteatomas, inflammatory granulomas, cholesterol granulomas, etc.), medication is “too far gone” to treat the problem. In fact, these problems need to be treated by ear microsurgery. The purpose of otitis media surgery is threefold: 1) to completely remove the lesion and obtain a “dry ear” instead of a chronically pus-filled ear; 2) to prevent serious complications caused by otitis media, such as facial paralysis, meningitis, brain abscess, etc.; 3) to repair or re-establish the sound transmitting structure of the “tympanic membrane-auditory ossicles-inner ear”, so as to improve the sound quality of the inner ear. 3. Surgery to repair or re-establish the “eardrum-auditory ossicles-inner ear” sound transmitting structure to improve the patient’s hearing. Commonly used surgical methods include: tympanic membrane repair, exploration and reconstruction of the auditory ossicles of the tympanoplasty; for otitis media granuloma or cholesteatoma inward and backward invasion of a large range of patients, need to carry out the sinus – mastoidectomy to remove the sinus and the mastoid lesions, and discretionary to take the integrity of the type or open tympanoplasty. If the patient’s auditory ossicles are destroyed or are unsuitable for preservation due to cholesteatoma erosion, reconstruction of the auditory chain using artificial auditory bones is required. In some severe and complicated cases of chronic suppurative otitis media, staged surgeries may be required to clean up the lesion and reconstruct the auditory ossicles in order to prevent inner ear infections and to minimize the chance of recurrence of the lesion. In order to minimize the financial burden on the patient and save treatment time, the surgeon will try to remove the lesion and reconstruct the hearing in the same operation. However, some patients still have unsatisfactory hearing recovery after surgery. Possible reasons for this include the formation of fibrous tissue or even scarring of the repaired or reconstructed tympanic membrane during the healing process, or the poor functioning of the eustachian tube leading to tympanic membrane invagination and adhesion, which in severe cases may cause the reconstructed auditory ossicles to become misaligned. In such cases, it is often necessary to choose a second-stage surgical exploration after one year. Therefore, the doctor will explain and communicate with the patient about the lesion and the possible effects after the surgery, and the doctor and patient will discuss together to make the most appropriate surgical plan. What I would also like to tell my friends is that chronic otitis media must be treated as early as possible and in a timely manner. Why is this? This is because chronic suppurative otitis media has a slowly progressing, gradually aggravating pathological process: in the early stages of the disease can be only a tympanic membrane perforation with inflammation and edema of the mucous membrane of the middle ear tympanic chamber, effective anti-infective treatment can be confined to the tympanic membrane and the tympanic chamber, manifested as a tympanic membrane perforation and a relatively mild hearing loss. If the infection is aggressively controlled at this stage, timely surgical treatment after dry ear is not only less extensive and takes less time, but also carries less risk of surgery. Patients usually have better hearing after surgery and rarely experience recurrent drainage. If not treated early, with repeated attacks of otitis media, purulent secretions continue to stimulate, inflammation to the deep and back of the spread of the formation of granulation tissue in the tympanic cavity and sinus, mastoid, the middle ear cavity ventilation and drainage channels are blocked by the granulation, the inflammation gradually aggravated, the effect of anti-infective treatment is not satisfactory, the ear is in the long time in the flow of pus or wet state. At this time, the perforation of the tympanic membrane will be enlarged, and the auditory ossicles may be destroyed or encapsulated by granulation, or sclerotic foci may be formed so that the auditory ossicles will be fixed, and the hearing will be significantly reduced at this time. Once combined with cholesteatoma of the middle ear will further aggravate the condition, there may be destruction of the facial nerve canal, the labyrinth of the inner ear, and also combined with neurodeafness. It is worth noting that with the prolongation of chronic otitis media, the function of the Eustachian tube will be irreversibly damaged, so that the middle ear cavity loses the ability to maintain normal air pressure and keep the tympanic membrane in its normal position. Surgical treatment at this stage is not only more extensive, but also more difficult and risky. This is because as the condition worsens, surgery is aimed at removing lesions in the tympanic chamber, sinus, mastoid and around the auditory ossicles and eustachian tube area, with autologous or artificial auditory ossicles for hearing reconstruction, if appropriate, or auditory ossicle reconstruction in the second stage. The postoperative outcome depends not only on the surgeon’s surgical technique, but also on the scope, nature and severity of the middle ear lesion and the functional status of the Eustachian tube. This shows that the surgical treatment of chronic suppurative otitis media should be done as early as possible.