Acute suppurative otitis media disease duration of more than 6~8 weeks, the lesion invades the middle ear mucosa, periosteum or deep to the bone, resulting in irreversible damage, often combined with the presence of chronic mastoiditis, known as chronic suppurative otitis media. Etiology Chronic suppurative otitis media is more commonly caused by repeated episodes of acute suppurative otitis media, untimely and incomplete treatment, resulting in chronicity. Chronic foci in the nose and pharynx, such as adenoid hypertrophy, chronic tonsillitis, chronic sinusitis, etc., as well as long-term obstruction or malfunction of the Eustachian tube may cause otitis media to persist for a long time. Common causative organisms include: Aspergillus, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, anaerobic bacteria, etc. It is often a mixed infection. Classification The disease is divided into 3 types, simplex, bone ulcer and cholesteatoma. There is generally no stage-related association between the various types, and bone ulcer type and cholesteatoma type may exist in combination. Clinical manifestations 1. Simple type Intermittent ear pus, pus is mucous or mucopurulent, not smelly. On otoscopic examination, perforation of the tympanic membrane is seen in the tense portion of the tympanic membrane, which is mostly of central type and of different sizes. Through the perforation, the tympanic mucosa is smooth and may be mildly edematous, and the auditory ossicles are mostly intact or only part of the hammertone stalk is necrotic. Audiological examination is generally mild conductive deafness. 2, bone ulcer type persistent ear pus, pus or mucopurulent pus, with blood, and often have a foul odor. Large perforation or marginal perforation of the tympanic membrane, through the perforation can be seen within the tympanic membrane there are granules or polyps, the auditory ossicles may have varying degrees of necrosis. The degree of hearing loss is related to the size and location of the perforation, whether the auditory ossicles are damaged and whether the inner ear is normal. Generally speaking, small perforations in the front and lower part of the tension section do not cause significant hearing loss, while large perforations in the upper part of the back can lead to more severe hearing loss. The usual scenario is conductive or mixed deafness with more severe hearing loss. CT of temporal bone shows soft tissue shadow or bone destruction area in the tympanic chamber, tympanic sinus or mastoid. 4.Cholesteatoma type Persistent, or intermittent if the amount of pus is too small or the perforation is covered by a scab. The secretory material is purulent, may contain “soya bean dregs”, and is malodorous. Hearing loss can be mild or severe, with mixed or sensorineural deafness in the later stages. Marginal perforation of the flaccid or tense portion of the tympanic membrane posteriorly and superiorly, with grayish scaly or pea-scum-like material. The posterior superior wall of the bony external auditory canal may collapse. Bone destruction is seen on mammogram or CT of the temporal bone with dense, sharp edges. It often causes intracranial and extracranial complications. Treatment 1, etiologic treatment Actively treat upper respiratory tract diseases, such as chronic sinusitis, chronic tonsillitis. Cure acute suppurative otitis media in time. 2, local treatment Simple type: according to the different conditions of the choice of local drugs, when the middle ear inflammation has been completely absorbed and subsided, the tympanic membrane perforation does not heal the feasible tympanoplasty. Bone ulcer type: if the drainage is smooth, the same as the simple type, mainly with medication, and regular review; if the drainage is not smooth, the conservative treatment is ineffective, or there are suspected complications, mastoidectomy should be carried out. According to the scope of the lesion, tympanoplasty, modified radical mastoidectomy and radical mastoidectomy can be performed. Cholesteatoma type: perform surgery as early as possible to remove the lesion and prevent complications.