A classification is proposed for chronic suppurative otitis media that includes six different types of pathological involvement, in addition to a normal ear and one with complications such as brain abscess, meningitis, labyrinthine fistula, or facial paralysis. The classification is determined primarily by otoscopic examination of the tympanic membrane and ear canal but is augmented by patient history and other physical tests. Each category requires specific different treatment or combinations of procedures. The categories of classification are: (1) Perforation of the tympanic membrane alone without evidence of other disease. (2) Conductive hearing loss with intact tympanic membrane. (3) Tympanic membrane perforation with disease confined to the middle ear and tympanum. (4) Attic cholesteatoma. (5) Disease involving the middle ear, epitympanum, and mastoid without cholesteatoma. (6) Disease involving the middle ear, epitympanum, and mastoid with cholesteatoma.