Overview
Chronic suppurative otitis media (CSOM) is persistent middle ear inflammation with discharge draining through a perforated tympanic membrane for more than 2 weeks. It presents with conductive hearing loss.
CSOM is thought to be a complication of acute otitis media (AOM), where a perforated tympanic membrane leads to recurrent middle ear infections and chronic inflammation. This can lead to the destruction of surrounding structures.
Epidemiology
- More common in the developing world
- 0.5% of adults and 0.9% of children in the UK have CSOM
Risk Factors
- Eustachian tube dysfunction, particularly Down’s syndrome or cleft palate
- Allergic rhinitis
- Acute otitis media – CSOM can develop if acute otitis media is left untreated
- Household smoking
- Low socioeconomic environments
- Winter months
- Crowded living
Presentation
Patients have persistent discharge through a perforated tympanic membrane with a duration of >2 weeks. features may be:
- Conductive hearing loss
- Persisting discharge >2 weeks
- There is usually no fever or otalgia
- Middle ear inflammation
- Tinnitus
- Aural fullness
Differential Diagnoses
Otitis media with effusion (glue ear)
- Fluid in the middle ear in the absence of signs/symptoms of an infection
- Effusion is seen with an air-fluid level/bubbles behind a normal tympanic membrane
- Patients usually present with conductive hearing loss
Acute otitis media
- May precede otitis media with effusion
- Pain and signs of infection present e.g. fever/malaise/irritability
Chronic suppurative otitis media
- Persisting inflammation and draining discharge for >2 weeks
- The tympanic membrane is usually perforated
- No fever or ear otalgia
Otitis externa
- There is no fluid in the middle ear
- The tympanic membrane is not bulging
- There may be tenderness of the tragus and pinna – movement is usually painful
Investigations
- Refer to ENT for assessment
- Do not swab the ear:
- There is not much evidence supporting its use
- Do not swab the ear:
- Audiogram:
- Shows a conductive hearing loss
- CT scans are usually used
- MRI may be used if soft tissues are involved
Management
- Routine referral to ENT – treatment is started by ENT specialists
- Management entails antibiotics, microsuction and surgery if needed
Complications
- Hearing loss
- Developmental delays in children
- Facial nerve palsy
- Mastoiditis
- Osteomyelitis of the petrous temporal bone
- Meningitis
- Brain abscess
- Death
Prognosis
- The prognosis is generally good
- Tympanic perforations usually heal spontaneously but can sometimes persist
