How long does it take for symptoms such as pus flow and hearing loss to improve after surgery in patients with chronic suppurative otitis media? Do I still need to change the medication or clean the ear canal? Most patients with chronic suppurative otitis media require surgery to eradicate the lesion, prevent continued pus flow, and avoid various complications. If the eardrum is simply perforated, surgery is sufficient to repair the eardrum and probe the inner ear’s sound transmission system – the auditory chain – to see if it is intact. However, the inflammatory stage is not suitable for surgery, and the inflammation needs to be controlled with 3% hydrogen peroxide or oxyfloxacin ear drops, and surgery can be performed after the purulent discharge from the ear is reduced and the tympanic chamber is drier, which can improve the success rate of surgery The success rate of surgery can be improved. During the postoperative healing period meatus and crust should be actively treated while some patients have slow epithelialization of the tympanic membrane after surgery, or meatus appears on the surface of the tympanic membrane, and discharge still occurs, at this time it is necessary to use antibiotic ear drops to prevent infection; or local change of medication to remove the meatus and promote normal epithelialization of the tympanic membrane. In addition, during the repair process of the tympanic membrane after surgery, patients may find that crusting on the surface of the tympanic membrane affects the vibration of the tympanic membrane, and this is the time to go to the hospital to find a doctor to clean it up. In conclusion, after the tympanic membrane is surgically repaired and foreign bodies such as inflammation and granulation are cleared and the tympanic membrane epithelializes, symptoms such as pus flow and ear pain can be cured. However, hearing problems should not be underestimated. Tympanic membrane perforation + restricted activity of the auditory chain If the activity of the auditory chain is restricted due to middle ear pathology and cannot receive vibration waves from the eardrum; or if the auditory tuberosity is interrupted, resulting in conductive deafness, then hearing reconstruction is required along with tympanic membrane repair surgery. This can be done by re-implanting an autologous sculpted auditory tuberosity or a titanium artificial auditory tuberosity to re-establish an effective sound conduction pathway between the tympanic membrane and the auditory chain. However, not every patient is a candidate for hearing reconstruction. A preoperative audiogram and CT of the temporal bone are required to determine the outcome based on the preoperative hearing condition and intraoperative exploration of the auditory chain. The postoperative outcome depends on the function of the auditory tuberosity and the eustachian tube. In theory, conductive deafness caused by chronic suppurative otitis media can be restored to normal after surgery. However, the final result depends on the functional status of the auditory chain and the function of the eustachian tube, and of course the surgeon’s skill and experience are also important factors. The normal function of the eustachian tube is an important factor in the long-term outcome of otitis media surgery. If the function of the eustachian tube is good, the hearing level can be restored to a relatively stable level within a month or so after surgery. If the eustachian tube is dysfunctional, the pressure inside the tympanic cavity cannot be balanced, which may affect the repair of the eardrum and even cause the eardrum to become trapped, resulting in ear stuffiness again; at the same time, excessive pressure outside the tympanic cavity may also cause the reconstructed auditory tuberosity to be displaced or the auditory chain to be interrupted, which will not guarantee the long-term effect of hearing reconstruction. Patients may feel that their hearing improves for a short period of time after surgery, but after a period of time, their hearing decreases again, accompanied by a feeling of stuffy ears. In addition, the invagination of the tympanic membrane may lead to the development of cholesteatoma. Fig. Eustachian tube structure If the mucous membrane of the nasopharynx swells due to problems such as upper respiratory tract infection or sinusitis, or if there is an increase in secretion, which blocks the pharyngeal opening of the eustachian tube, the interface between the eustachian tube and the nasopharynx (see figure), the function of the eustachian tube may also be affected, resulting in unstable hearing results after surgery. In this case, medication should be used to promote the recovery of the function of the eustachian tube, for example, the application of nasal spray hormone and the use of drugs such as mucus promoters. If necessary, nose puffing and balloon blowing can also promote the recovery of the eustachian tube function. Regarding intraoperative injury to the facial nerve, the chance of injury to the facial nerve during tympanic surgery for chronic suppurative otitis media is still relatively low. In other words, it is less likely that immediate facial paralysis will occur. However, patients with otitis media may experience postoperative delayed facial palsy, which means that facial palsy does not occur immediately after surgery, but usually 3 to 7 days after surgery. The exact cause of this delayed facial palsy is still unclear, but it is speculated that it may be caused by the swelling of the facial nerve after the use of some filling materials or cold water stimulation during the surgery. For this delayed facial palsy, it needs to be treated with oral hormone therapy, and it can generally return to normal within 1~3 months.