Chronic Suppurative Otitis Media (CSOM) is a perforated tympanic membrane (ear drum) with persistent drainage from the middle ear. CSOM is defined as chronic otorrhea (ie, >6-12 wk) through a perforated tympanic membrane (TM). It is initiated by an acute episode of Infection. Commonest are bacteria which cause these infections. Treatment would include A culture should be obtained for sensitivity. Medical measures like The antibiotic should have an appropriate spectrum of activity that includes gram-negative organisms, especially pseudomonads, and gram-positive organisms, especially S aureus. Aural toilet is a critical process in the treatment of CSOM. Prior to instituting systemic therapy, a culture should be obtained for sensitivity. Systemic therapy should be continued for 3-4 weeks. Surgical procedure is for those who are medically unresponsive. The pain behind the air could be Mastoiditis. It is a bacterial infection of the mastoid air cells (small, air-filled cavities located in the mastoid process, which is the bulge in the skull behind the ear). If the infection persists, it may destroy the delicate structures of the mastoid. This can result in hearing loss and, without treatment, continued destruction of bone in the skull. It shoule be promptly treated and please rush to an ENT surgeon to prevent life threatening complications.