Mr. Li is usually in good health and enjoys swimming, ball games and other sports activities. However, in the past year, both ears have been flowing pus intermittently for unknown reasons, accompanied by tinnitus and stuffy ears. Mr. Li thought it was water in his ears from swimming, so he didn’t care and went to the pharmacy to buy some “anti-inflammatory tablets” and “ear drops” for himself. However, in recent weeks, he found that the pus in his ears had increased and smelled bad, and occasionally there was some pus and blood, and his hearing was significantly worse than before. After a detailed examination, Dr. Zhang of the Department of Otolaryngology diagnosed him with “chronic purulent otitis media on the left side and middle ear cholesteatoma”. After timely surgery, Mr. Li recovered and was discharged from the hospital. Chronic pus in the ear seems to be common, and many people do not pay attention to it or even consider it as a disease. What is this chronic suppurative otitis media all about and what are the dangers? Chronic suppurative otitis media is usually caused by acute suppurative otitis media that has not been properly and thoroughly treated and is prolonged; it is also related to chronic inflammation of the nose and pharynx that causes otitis media to recur and not heal over time; a decrease in systemic or local resistance, such as malnutrition, chronic anemia, diabetes, etc., is also a cause of chronic suppurative otitis media. The common causative agents are Staphylococcus aureus, Pseudomonas aeruginosa, as well as Aspergillus and Klebsiella. In cases of longer duration, there is often a mixture of two or more bacteria, and the strains often change. What are the clinical manifestations of chronic suppurative otitis media? The clinical manifestations of chronic suppurative otitis media are related to the extent of the lesions and can be divided into three types: The first type is chronic simple suppurative otitis media, in which the inflammatory lesions are mainly located in the mucosal layer of the middle ear tympanic chamber, causing perforation of the tympanic membrane, usually without granulation, and rarely destroying the auditory tuberosity. The typical symptom is intermittent pus flowing from the ear. The pus flowing from this type of chronic otitis media resembles mucous nasal discharge and is usually odorless, with the pus flowing on and off. The condition can come and go. It often recurs after a cold or water flows into the ear and is associated with mild to moderate hearing loss. The second type of otitis media is chronic osteochondritis suppurativa, or chronic granulomatous suppurative otitis media. This is a more severe form of otitis media with more pus flowing from the ear that lasts for a longer period of time, and the pus may have blood in it or bleeding in the ear. The long-term pus flow in this type of otitis media is difficult to control with systemic or local antibiotic treatment. In severe cases, various complications can also occur due to destruction of the surrounding structures by the granulation or poor drainage of the pus. Hearing is also worse than in the first type of otitis media because the auditory tuberosity is often encapsulated or eroded by the granulation. The third type is cholesteatoma otitis media, or middle ear cholesteatoma. This is the most dangerous type of chronic suppurative otitis media. The cholesteatoma here is not a “malignant tumor” in the usual sense. It is caused by the long-term perforation of the tympanic membrane or the edge of the tympanic membrane, which causes squamous epithelial cells on the outer surface of the tympanic membrane and external auditory canal to grow into the middle ear cavity. The cholesteatoma is a type of otitis media that is characterized by a tumor-like invasion and destruction of the surrounding bone by compression and erosion. Cholesteatoma otitis media is the most dangerous because of its destructive nature. It can destroy all of the auditory bones causing hearing loss, invade the inner ear vagus causing vertigo, destroy the facial nerve canal causing facial palsy, and destroy the skull base bone and meninges upward leading to intracranial infections such as meningitis and brain abscess, which can be life-threatening in severe cases. Patients suffering from this type of chronic otitis media may only have pus and deafness for a long time, but once the pus becomes more, smelly, or bloody, or if headache, dizziness, or distortion of the mouth occurs, one must be alert to the destruction of cholesteatoma.