Chronic suppurative otitis media
Chronic suppurative otitis media is continuous otorrhea through a perforated tympanic membrane for more than six weeks without systemic symptoms. Management starts with topical fluoroquinolone ear drops and aural toilet, escalating to systemic antibiotics or tympanoplasty for refractory disease or cholesteatoma.
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What this article covers
- Overview
Chronic perforation with drainage: chronic suppurative otitis media (CSOM) is continuous suppurative drainage through a perforated tympanic membrane, distinguishing it from acute otitis media, which…
- Epidemiology
Sequela of recurrent or undertreated otitis media: recurrent or undertreated acute otitis media episodes are the pathway to chronic otitis media, cholesteatoma, and mastoiditis in adults.
- Risk factors
Recurrent or undertreated acute otitis media: the dominant risk factor; repeated middle ear infections that fail to clear predispose to persistent perforation and chronic suppuration.
- Pathophysiology
Persistent perforation as the anatomic substrate: a tympanic membrane perforation that fails to heal keeps the middle ear mucosa exposed to the external environment, allowing repeated bacterial contamination.
- Clinical features
Continuous otorrhea for more than 6 weeks: the hallmark and diagnostic threshold; drainage that persists beyond 6 weeks, in the setting of a visible tympanic membrane perforation, defines the disease.
- Differential diagnosis
Acute otitis media: shares otalgia, tympanic membrane changes, and possible rupture, but symptoms are acute and drainage does not persist beyond weeks; systemic symptoms (fever) are more typical.
- Diagnosis
Clinching basis: CSOM is confirmed by otoscopy showing a tympanic membrane perforation plus continuous suppurative drainage persisting for more than 6 weeks; this perforation-plus-6-week combination…
- Management
First, aural toilet: clean and dry the ear canal (for example with a wick or gentle suction/irrigation) to remove debris and purulent material before instilling any topical agent; this step is foundational and precedes drug therapy.
- Complications
Cholesteatoma: chronic ear infection and tympanic membrane perforation permit migration of squamous epithelium into the middle ear, forming a cyst that erodes the ossicles, mastoid, and external…
- Prognosis
Favorable with topical therapy for uncomplicated disease: most uncomplicated CSOM responds to aural toilet and a 7-day course of topical fluoroquinolone drops, with resolution of drainage and mucosal healing.
- Prevention
Adequate treatment of acute otitis media to prevent progression: treating acute episodes appropriately, including amoxicillin-clavulanate when indicated, reduces the risk of the recurrent or…
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Related articles
- Acute otitis media
Acute otitis media is a suppurative middle ear infection, mostly in young children, diagnosed by otoscopy showing a bulging, erythematous tympanic membrane with an effusion, and it is treated with observation or amoxicillin depending on age and severity.
- Cholesteatoma
Cholesteatoma is an abnormal growth of keratinizing squamous epithelium in the middle ear that erodes the ossicles, mastoid, and adjacent skull base; it is confirmed on otoscopy, staged by CT, and requires mastoidectomy with tympanoplasty because no medical therapy is curative.
- Mastoiditis
Acute mastoiditis is a suppurative infection of the mastoid air cells, almost always arising as an extension of untreated or inadequately treated acute otitis media. It is diagnosed clinically by postauricular erythema, tenderness, and swelling with the auricle displaced anteriorly, and is treated with intravenous antibiotics escalating to myringotomy or mastoidectomy when abscess or complications are present.
- Tympanic membrane perforation
A full-thickness defect in the eardrum from trauma or infection, causing sudden ear pain, conductive hearing loss, and otorrhea. Diagnosis is by otoscopy. Most heal spontaneously with dry-ear precautions; a draining ear is treated with ofloxacin otic drops, and a perforation that fails to close by 3 months is referred for myringoplasty or tympanoplasty.
- Otitis media with effusion
Otitis media with effusion is middle-ear fluid persisting without signs of acute infection, most often in young children after an upper respiratory infection or acute otitis media, managed mainly with observation and reserving tympanostomy tubes for persistent hearing loss.
- Otitis externa
Otitis externa is diffuse inflammation of the external auditory canal, usually bacterial (Pseudomonas or Staphylococcus aureus) and diagnosed clinically by tragal tenderness and canal erythema with otorrhea. Uncomplicated disease is treated with topical antibiotic-steroid otic drops for 7 days, while malignant (necrotizing) otitis externa in a diabetic or immunocompromised patient is skull-base osteomyelitis requiring systemic antipseudomonal therapy and urgent otolaryngology referral.
- Hearing loss
Hearing loss is evaluated with the Weber and Rinne tuning fork tests to sort conductive from sensorineural loss at the bedside, then confirmed with audiometry; treatment ranges from cerumen removal or hearing aids to urgent oral prednisone and otolaryngology referral for sudden sensorineural loss.
- Brain abscess
Brain abscess is a focal, ring-enhancing suppurative infection of the brain parenchyma most often from contiguous sinus, ear, or dental spread or hematogenous seeding, diagnosed by contrast MRI and image-guided aspiration and treated with predisposing-source-directed empiric antibiotics plus drainage of abscesses larger than 2.5 cm.