chronic suppurative otitis media

Question 1

what is chonic suppurative otitis media?

Answer 1

a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges (otorrhoea) through a tympanic perforation

seen as a complication of AOM

Question 2

what organisms are thought to cause CSOM?

Answer 2

• Pseudomonas aeruginosa (most common).
• Staphylococcus aureus.
• Proteus species.
• Aspergillus species.
• Candida albicans.

Question 3

what are the risk factors for CSOM?

Answer 3

• Younger age - children under five years old are most commonly affected.
• Allergy/atopy.
• Upper respiratory tract infection.
• Acute or recurrent otitis media.
• Exposure to second-hand smoke.
• Social deprivation.
• Snoring.

Question 4

what are the complications of CSOM?

Answer 4

• hearing loss
• facial paralysis, mastoiditis, petrositis
• meningitis, cerebral abscess
• death

Question 5

when should CSOM be suspected?

Answer 5

• ear discharge >2 weeks, without ear pain or fever
• hearing loss
• history of AOM/ear trauma/ glue ear
• examination of ear may reveal tympanic membrane perforation and/or middle ear inflammation

serious complication symptoms include

• headache
• nystagmus
• vertigo
• fever
• labyrinthitis
• facial paralysis
• swelling/tenderness behind ear

Question 6

what are the differentials of CSOM?

Answer 6

• otitis externa
• otitis media with effusion
• foreign body
• impacted ear wax
• cholesteatoma
• neoplasm

Question 7

how should a person with chronic suppurative otitis media be managed?

Answer 7

• signs of serious complication, ENT referral
• do not swab or initiate treatment, refer to ENT
• advise person to keep affected ear dry