Chronic

Suppurative
Otitis Media

Presented; MOHD YUSOF BIN YAMIN

14 MAY 2008
 CSOM
• CSOM is a long standing infection of
a part or a whole of middle ear cleft
characterized by ear discharge and
permanent perforation.

middle ear
 Types of CSOM
• Clinically, it is divided into 2 types;
– Tubotympanic
– Atticoantral
 Features
• Ear discharge
– Non-offensive, mucoid or
mucopurulent.
– Constant or intermittent
– Discharge appears mostly
when URTI or water
accidently enters the ear
• Hearing loss
– Conductive type
– In long standing, it can
become mixed type due to
cochlea damage
 Cont.
• Perforation
– Always central
– May lie ant., post. or inf. to
handle of malleus
• Middle ear mucosa
– Seen when perforation is
large
– Normally it is pale pink
and edematous red if
inflammed
– Sometimes polyp can be
seen
 Investigations
• Microscopic exam. of edge of
perforation – granulation, in-growth
squamous epithelium.
• Audiogram – to assess the degree of
hearing loss and the type
• Culture and sensitivity of the ear
discharge
• Mastoid x-ray – mastiod usually
sclerotic but may be pneumatised
with clouding of air cell, without bone
Radiogram showing sclerotic
(poorly pneumatized) mastoid
air cells.

Radiogram showing
well-pneumatized mastoid
air cells.
 Treatment
• Aims – to control infection, eliminate
ear discharge, correct hearing loss
2.Aural toilet
– Remove all discharge and debris by
mopping with cotton wool, suction
clearance under microscope, and
irrigation
 Cont.
1. Ear drops
– Antibiotic ear drops containing
neomycin, polymyxin, chloromycetin or
gentamicin.
– They are combined with steroids which
has anti-inflammatory effect
2. systemic antibiotic
– Useful in acute exacerbation of
chronically infected ear.
 Cont.
1. Precautions to patient
– Keep water out of ear during bathing,
swimming
– Avoid hard nose blowing – may push
the infection in nasopharynx to middle
ear
2. Treat the contributory cause –
infected tonsil, adenoids, maxillary
antra, nasal allergy
 Cont.
1. Surgical treatment – if there is aural
polyps or granulation is present
2. Reconstructive surgery –
Myringoplasty with or without
ossiculoplasty