The middle ear is located deep in the external auditory canal and includes the tympanic chamber, sinus, eustachian tube and mastoid process, and is adjacent to important structures such as the facial nerve, inner ear and cranial brain. Under normal circumstances, the middle ear is isolated from the outside world by the tympanic membrane, remains sterile, and plays an important role in the auditory formation mechanism. Acute suppurative inflammation of the middle ear can be caused by many factors, leaving the tympanic membrane perforated, leaving the middle ear in direct communication with the bacterial environment, which is always bacterial and prone to chronic suppurative otitis media. Chronic suppurative otitis media is a common clinical condition that can have no obvious symptoms in the interval, but acute attacks of chronic inflammation are often triggered by upper respiratory tract infections, water in the ear canal, and overexertion. The disease is characterized by tympanic membrane perforation, recurrent ear canal drainage, and hearing loss, and is essentially a purulent inflammation of the middle ear mucosa, periosteum, or deep to the bone. Repeated episodes of chronic suppurative otitis media will inevitably lead to the destruction of the middle ear itself and adjacent structures, resulting in progressive deafness, as well as vertigo and facial paralysis. In the pre-reform era, when medical conditions were relatively underdeveloped, cases of otitis media leading to life-threatening cranio-cerebral complications were common. People usually think that chronic suppurative otitis media only causes hearing loss and pus flowing from the external ear canal and can be controlled by oral antibiotics or local application of ear drops. The choice of treatment for chronic suppurative otitis media depends on the type of lesion. According to the different pathological characteristics and clinical manifestations of chronic suppurative otitis media, we classify them into three types: simple chronic suppurative otitis media, osteochondritis chronic suppurative otitis media and cholesteatoma otitis media. Since the latter two types often lead to serious destruction of bony structures and easily induce various complications, these two types of patients should be operated early. In the case of simple chronic suppurative otitis media, it was previously thought that the disease did not impair sensorineural function and that conservative treatment was sufficient to control the infection, but a large sample of patients with simple chronic suppurative otitis media reported in a 2008 study in a prestigious international journal that sensorineural hearing function was much worse than normal, and that this degree of hearing loss increased significantly with the duration of the disease and was more severe in elderly patients. It is assumed that this is related to the chronic toxic effect of bacterial toxins on the inner ear that remain in the middle ear cavity after infection. This study suggests that even simple chronic suppurative otitis media requires early surgery to avoid irreversible damage to sensorineural function from chronic inflammation. The main purpose of surgery for chronic suppurative otitis media is to remove the lesion and completely control the infection. Our department has performed various types of tympanoplasty for nearly 6,000 patients with chronic suppurative otitis media, with definite results and postoperative complications of only about 1%, which is similar to recent reports in developed countries. In principle, for patients with relatively mild inflammation and no destruction of the auditory tuberosity, a first-stage procedure can be performed, while for patients with relatively severe inflammation and destruction of the auditory tuberosity, in order to ensure complete removal of the inflammation and long-term results of the surgery, most patients need a first-stage procedure to remove the lesion and reconstruct a clean middle ear cavity including an intact tympanic membrane, followed by a second-stage procedure six months later to reconstruct the sound-transmitting structures. In accordance with international standards and our own experience, we perform individualized tympanoplasty depending on the specific damage to the middle ear seen intraoperatively: for those with no sarcoid, cholesteatoma, or bone destruction within the tympanic cavity, type I tympanoplasty is performed, and hearing can be significantly improved after surgery. Type II tympanoplasty can be performed for those with perforation of the tympanic rim or relaxation, sarcoma and cholesteatoma in the tympanic chamber, and minor destruction of the auditory tuberosity. For more severe lesions with interrupted auditory chain and intact stapes, type III tympanoplasty is performed, in which the tympanic chamber and auditory chain are reconstructed by direct adhesion of the reconstructed tympanic membrane to the stapes bone. For those who have a large part of the auditory bone destroyed but the residual stapes are still movable, after removing the lesion, a small tympanic chamber with a round window connected to the eustachian tube is built by using the reconstructed tympanic membrane, which can improve sound conduction to improve hearing. In the case of residual stapes fixation, a small tympanic chamber is surgically created and then a window is opened in the horizontal semicircular canal so that sound waves can be transmitted to the inner ear through the artificial window to improve hearing, which is called type V tympanoplasty. Our experience is that the use of each type of tympanoplasty can not only completely remove the lesion, but also significantly improve hearing. With the increasing life expectancy, the pursuit of quality of life, and the gradual appreciation of the importance of auditory function, the danger of chronic suppurative otitis media to a healthy life is becoming more and more apparent. Early diagnosis and treatment is the only way to save the ear from the disease, avoid further damage, and get a better chance to improve hearing.