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 the history of crookedness of the mouth. The patient will also undergo a comprehensive otolaryngologic 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 tympanic chamber, and the presence of cholesteatoma formation under an ear endoscope or microscope. In order to accurately assess the patient’s hearing a series of audiological examinations are also performed, including pure tone hearing threshold determination, middle ear analysis (acoustic conductance, stapedius muscle reflex), etc. Through the hearing examination, we can initially determine the degree of hearing damage caused by otitis media, whether there is any damage to the auditory chain, whether there is any combined neurological deafness, etc. A CT examination of the ear (temporal bone spiral CT) should also be done. Why do we need CT examinations 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 display 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 loss of the auditory chain, determine the type of otitis media, 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 granuloma-like tissue is unknown, sometimes it is necessary to clamp some of the tissue for a pathological biopsy, which can help determine whether the proliferation is a malignant tumor or a benign inflammatory granuloma. After completing the necessary tests, the doctor will have a detailed assessment of the overall understanding of the patient’s otitis media condition, and the next step will be to develop an individualized treatment plan for the patient.