Middle Ear Conditions (Chronic Suppurative Otitis Media(CSOM))

As the name suggests this condition should have symptoms lasting more than three months, be the result of infection and involve the middle ear cleft. There are two types of CSOM, namely tubotympanic and atticoantral.

What is Tubotympanic Disease?

This type involve the Eustachian tube (tubo-) and the tympanum (middle ear). The classical feature is a central perforation of the tympanic membrane. In general, perforations secondary to ASOM heal spontaneously, but when the acute infection is inadequately treated or if chronic infection sets in, then the perforation may not heal, resulting in a chronic perforation, and hence the name. The bacteria found include Pseudomonas, beta- haemolytic Streptococcus and Haemophilus influenzae.

Symptoms and Signs

The most common symptoms are ear discharge and deafness. Pain is uncommon although itchiness can occur due to secondary external otitis. The discharge is usually odourless and mucoid in nature. Tuning fork tests will point to a conductive hearing loss in the affected ear.

Investigation

Culture and sensitivity of the discharge is taken in cases where treatment is resistant or protracted. An audiogram is always performed prior to any surgical intervention.

Management

Concurrent infection is best treated with combined steroid and antibiotic ear drops (Framycetin, Ciprofloxacin HC, Ofloxacin). Once the infection has settled down for at least one month, surgical closure of the perforation under GA is advised. It is important to be aware of the risks of inner ear damage resulting from the use of aminoglycoside antibiotic ear drops in the presence a perforation and prolonged use is hazardous.

Complications

This form of CSOM is generally not associated with long-term complications. The most common complication is disruption of the ossicular chain which can be repaired during surgical closure of the perforation.