GP - Chronic suppurative otitis media (CSOM)

Question 1

What is chronic suppurative otitis media?

Answer 1

Chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges through a perforated eardrum (wet perforation), with conductive hearing loss

Question 2

Where in the eardrum the perforation is more dangerous and life-threatening?

(Tubotympanic or atticoantral perforation)

Answer 2

Tubotympanic perforation (perforation in the centre) - safe since it’s not likely to be associated with cholesteatoma

Atticoantral perforation (perforation at the top) - unsafe since it’s likely to cause cholesteatoma

Question 3

How is AOM different from CSOM?

Answer 3

AOM is considered to be CSOM after at least 2 weeks of ear discharge, hence CSOM is a complication of AOM

Question 4

What organisms cause CSOM?

Answer 4

Bacteria - Pseudomonas aeruginosa (most common), Staphylococcus aureus

Question 5

List risk factors for CSOM

Answer 5

• Young age
• AOM/ recurrent otitis media
• URTI
• Allergy/ atopy

Question 6

What clinical features does a patient with CSOM typically present with?

Answer 6

Presentations:

• Ear discharge lasting 2 weeks or more, with NO ear pain or fever
• Conductive hearing loss, tinnitus, aural fullness
• Hx of AOM, OME, ear trauma
• Hx of URTI, allergy, atopy
• Signs/ otoscopy findings:
  
  • Wet perforation of the eardrum
  • Middle ear inflammation
  • Presence of granulation tissue

Question 7

Suggests symptoms that indicate potential serious complications of CSOM

Answer 7

• Vertigo
• Labyrinthitis
• Facial paralysis
• Mastoiditis
• Headache

Question 8

How would you manage CSOM?

Answer 8

Management:

• Urgent same day referral to ENT if suspected of complication
• Routine referral within 2 weeks for those without complication
• Advise to keep ear dry
• Do NOT swab ear or initiate treatment