When a patient with chronic otitis media arrives at the hospital, a series of routine tests are usually completed to get a full and accurate picture of the condition. First, the doctor will take a detailed history and symptoms of the patient, paying special attention to the duration and progression of hearing loss, the presence of vertigo and headache, and a history of crookedness of the mouth. The patient will also undergo a comprehensive otolaryngology examination to check the shape of the middle ear pus, the location and size of the tympanic membrane perforation, the formation of granulation in the external ear canal and middle ear bullae, and the presence of cholesteatoma formation under an endoscope or microscope. In order to accurately assess the patient’s hearing a series of audiological tests are also performed, including pure tone hearing threshold determination, middle ear analysis (acoustic conductance, stapedius muscle reflex), etc. A CT (spiral CT of the temporal bone) of the ear is also done. Why do we need CT examination for otitis media? The middle ear is located inside the temporal bone, which has a complex anatomy and fine structure. Spiral CT of the temporal bone can not only clearly show the middle ear auditory tuberosity, facial nerve, tympanic cap, sigmoid sinus and other adjacent important structures, but also accurately locate microscopic cholesteatoma or granuloma in the middle ear, and can show the extent of surrounding bone destruction and hearing bone chain loss, determine the type of otitis media and predict the occurrence of intracranial complications at an early stage, and estimate the difficulty of surgery. CT examination is very helpful in the diagnosis and selection of the surgical procedure, and has obvious advantages. In rare cases, magnetic resonance imaging (MRI) may be required to help determine this. Laboratory tests: Pus from the middle ear is taken for bacterial culture and drug sensitivity testing to identify the type of bacteria causing the infection and the best antibiotic to use. Tissue biopsy: If the nature of the middle ear granulation-like tissue is unknown, it is sometimes necessary to clamp some of the tissue for pathologic biopsy, which can help determine whether the proliferation is a malignant tumor or a benign inflammatory granulation.