This morning I was on duty when Dr. Zhang from the brain surgery department called, saying that a comatose patient had pus coming out of his ear and wanted me to help clean it up. I rushed over with my otoscope. This was a comatose female patient, in her 40s, diagnosed with brain abscess, in the intensive care unit, with all kinds of tubes stuck in her body. When I examined the patient, there was a large amount of pus in the left ear with a foul odor. I immediately looked through the medical records, could it be a complication from otitis media? I was alerted. I asked for the patient’s CT film and read it carefully. I found an abscess in the temporal lobe of the left side of the brain, a midline shift, signs of inflammation in the middle ear mastoid, and bone destruction. After asking the family member about his wife’s left ear abscess for 18 years, which had been on and off, she suddenly developed headache and fever a month ago, and no problem was detected at the local hospital, then she was treated at a large hospital, and a week ago she developed impaired consciousness and was referred here. Based on these circumstances, I concluded that this was chronic suppurative otitis media combined with intracranial infection and the formation of brain abscess, which is a more serious complication of cholesteatoma-type otitis media and must be operated immediately. The family members were very confused and asked me if the otitis media was that serious. In fact, chronic suppurative otitis media is one of the common diseases in otolaryngology with a high incidence, and is generally divided into simple, osteoid and cholesteatoma types. Complications of otitis media are many and complex, ranging from perforation of the eardrum and pus flowing from the ear in mild cases to destruction of bone causing complications in severe cases. Some common complications include hearing loss due to damage to the auditory bone, which can cause inconvenience in life and work, facial paralysis due to damage to the facial nerve canal, or vertigo due to vaginitis caused by damage to the semicircular canal, or even life-threatening conditions. Since the middle ear is located close to the skull and is separated from the skull only by the bone plate, inflammation can easily break through the bone plate and enter the brain, leading to life-threatening complications such as temporal lobe abscess and cerebellar abscess. In this patient, the cholesteatoma destroyed the bone at the base of the skull, and the inflammation entered the skull causing a temporal lobe abscess. Most chronic suppurative otitis media can be controlled by conservative medication in the early stages, and tympanic membrane perforations can heal on their own. If the perforation does not heal on its own, the tympanic membrane can be surgically repaired to prevent reinfection. If there is damage to the auditory bone, tympanoplasty is required. This surgery can not only completely remove the lesion and obtain a radical cure, but also repair the eardrum and rebuild the auditory bone chain to improve hearing. In the case of intracranial complications, early surgery is necessary to remove the lesion and save the patient’s life. Through my explanation, the family readily accepted the surgery. I scheduled an emergency surgery that afternoon and extracted more than 10 ml of pus from her brain through the bone destruction and placed a drain. The patient woke up a week later and was able to get out of bed two weeks later. She smiled happily when I told her that she could also undergo tympanoplasty to restore her hearing in six months.