CSOM is a neglected tropical disease affecting 330 million people worldwide and is the most common cause of permanent hearing loss among children in developing countries. Pseudomonas aeruginosa (PA) is the leading cause, initially generating acute otitis media and later converting from a planktonic to biofilm state. We have created and validated CSOM mouse model. We concluded that SNHL severity depends on the exposure to specific phenotypes of PA, and Macrophages are recruited and are the key innate immune cells in the cochlea of CSOM.