”Chronic suppurative otitis media” is the verdict of the doctor for the patient, but why? (1) Rigid endoscopy The different forms of the tympanic membrane, the presence or absence of secretions, the site of perforation, the mucosa of the tympanic chamber, and the condition of the auditory chain can all be visualized by rigid endoscopy. Different phenomena can help the doctor diagnose different diseases. If it is a tight perforation with pus, chronic suppurative otitis media is very likely, but if it is a loose perforation, then it is likely to be a middle ear cholesteatoma. (2) Hearing examination In the article “What is chronic suppurative otitis media? (link)”, I mentioned that the main function of the middle ear is to transmit sound from the outside to the inner ear, and a hearing examination is a test of this function. The middle ear is a hollow structure with many air spaces and holes inside, and the middle ear is connected to the nasopharynx via the eustachian tube. If the eustachian tube is inaccessible, the acoustic conductivity map may appear as a negative pressure, and if there is fluid in the middle ear, the acoustic conductivity map may appear as a low, flat line. (3) CT scan of the temporal bone is a revolutionary technology that has helped medicine take off. It gives doctors a pair of “eyes of gold” and allows them and patients to see what structures are inside the body, what is wrong, what to do during surgery, what to pay attention to during surgery, and where there are dangers. Of course, each patient is an individual with strong personal characteristics, and the above are only the most basic tests. For patients with different conditions and causes, additional tests such as MRI, DSA, etc. may be required to clarify the diagnosis. In short, the goal of doctors and patients is the same: to understand “what is it? Why? What to do?” To avoid misdiagnosis and underdiagnosis, and to strive for early recovery.