Otitis Media, Chronic Suppurative (CSOM)

Notes
  • Chronic suppurative otitis media occurs after the initial episode of acute otitis media and it is characterized by a persistent discharge from the middle ear through a tympanic perforation.
  • CSOM is a critical cause of preventable hearing loss.

##Causes of CSOM include:

  • Acute otitis media with perforation that has not been treated at all or if treated, the treatment was ineffective
  • Recurrent URTIs
  • Secondary infection(s) with Gram-negative bacteria, fungi or yeast.

##Epidemiology and Statistics

  • Globally, 65-330 million people have draining ears.
  • Globally, 39-200 million people suffer from a significant hearing impairment.
  • Globally, CSOM accounts for 28,000 deaths.
  • Globally, CSOM accounts for > 2 million DALYs.
  • CSOM prevalence in Kenya and Brazil – 1 to 2%
  • CSOM prevalence in Tanzania and India - >4%
  • Developing countries account for > 90% of the global burden of CSOM

##Risk factors for CSOM

  • Multiple episodes of Acute Otitis Media
  • Children attending daycare
  • Living in a crowded environment
  • Craniofacial disorders e.g. cleft palate and Down's syndrome
Symptoms
  • Otorrhoea (clear to purulent discharge) from one or both ear(s) for >2 weeks that can be a newly discharging untreated ear, persistently discharging initially treated ear and a recurrently discharging ear
  • Otalgia (pain in the ear)
  • Headache
  • Fever
  • Vertigo
  • Dizziness
  • Impaired hearing
  • It may lead to cholesteatoma and loss of hearing as well as mastoiditis
  • Perforation in the tympanic membrane
  • Edema of external auditory canal
Diagnosis
  • Clinical evaluation
  • An audiogram to assess the degree of loss of hearing
  • CT Scan and MRI may be done to assess the scope of damage by CSOM
Differential
  • Chronic otitis externa
  • Foreign body
  • Impacted earwax
  • Neoplasm
  • Wegener's granulomatosis
Prevention
  • Prompt treatment of acute otitis media
Management
  • Analgesics such as: Syr/Tabs Paracetamol  10mg /Kg TID x 5/7
  • Antibiotics such as: Syr / Caps Amoxicillin 25 – 50mg /kg  TID x 5/7 or  Susp/Tabs Erythromycin  30 – 50mg /kg TID x 5/7

(NB: topical quinolones can be effective in resolving otorrhoea)

  • If the patient has not improved after 5 days, repeat the above treatment.
  • Topical steroids (to reduce granuloma formation) and it is used combined antibiotic/steroid preparations

##Drying the ear by wicking:

  • The mother / guardian is shown how to keep the ear dry by wicking
  • A piece of cloth or cotton wool is rolled into a wick
  • It is inserted carefully into the ear and rolled gently
  • Remove and examine it for wetness
  • If wet, repeat the procedure several times until it is dry.
  • This procedure is repeated QID until the time when the ears will be dry

##Surgical interventions:

  • Myringoplasty (repair of the eardrum perforation)
  • Tympanoplasty (repair of the eardrum and surgery involving the bones of the inner ear)
  • Cochlear implants (after the cure of CSOM)
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