Today, I met a patient with cholesteatoma otitis media who was very afraid of the possibility of facial paralysis after otitis media surgery and had great concerns about the surgery. I have a feeling that many patients still have inadequate knowledge and misconceptions about surgery for otitis media, so I would like to talk about this in a rough way. For patients with otitis media, cholesteatoma is like a time bomb buried in the body. Its special pathological mechanism can lead to many high-risk complications such as meningitis, labyrinthitis and peripheral facial palsy (see my article: Don’t ignore the “ear base” – cholesteatoma otitis media must be treated early). Therefore, once diagnosed, it needs to be treated with surgery as soon as possible. However, in otitis media surgery, peripheral facial palsy is a very painful complication that seriously affects the patient’s quality of life. Many patients, due to fear, are hesitant to undergo surgery and thus miss the opportunity for early treatment. If the cholesteatoma destroys the osseous canal of the facial nerve and damages the facial nerve (in some patients, there is a congenital absence of the osseous canal of the facial nerve, and the sheath of the facial nerve is directly exposed in the middle ear cavity), even if surgery is performed, the facial palsy will not be easily recovered, which will definitely leave the patient with lifelong pain and regret. In fact, the chance of peripheral facial palsy during otitis media surgery is very small, with the highest incidence reported in the literature to be around 0.5%. The main reasons for postoperative facial palsy are: the lesion is so severe that it has eroded into the osseous canal or sheath of the facial nerve, causing edema of the facial nerve during the separation of the lesion; the facial nerve is completely encapsulated by the cholesteatoma, and the removal of the lesion inevitably causes damage to the blood vessels supplying the perineurium, which in turn causes ischemia of the facial nerve; and the individual sensitivity of the facial nerve causes thermal damage to the surgical drill. It can be seen that postoperative complications occur mostly in those cases with more serious conditions and longer disease duration. Therefore, the earlier the surgery, the more likely it is that postoperative facial paralysis will be avoided. Nowadays, with the development of microsurgery technology, the instruments and medical technology have been refined to fully guarantee the safety of the surgery. In other words, for cholesteatoma otitis media, the risk of facial palsy caused by surgery is much lower than the risk of delayed treatment without surgery, and early surgery is the only way to completely avoid complications. As a microsurgeon, it is my lifelong goal and happiness to help patients with cholesteatoma otitis media to be free from the pain and suffering of the disease.