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Key Features

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  • Persistent otorrhea in a child with tympanostomy tubes or tympanic membrane (TM) perforation

  • Starts with an acute infection that becomes chronic with mucosal edema, ulceration, granulation tissue, and eventual polyp formation

  • Risk factors include a history of multiple episodes of otitis media, living in crowded conditions, day care attendance and being a member of a large family

  • Most common associated bacteria include Pseudomonas aeruginosa, Staphylococcus aureus, Proteus species, Klebsiella pneumoniae, and diphtheroids

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Clinical Findings

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  • Ongoing purulent ear drainage

  • Nonintact TM: perforation or tympanostomy tubes

  • May be associated with cholesteatoma

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Diagnosis

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  • Clinical

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Treatment

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  • Visualization of the TM, meticulous cleaning with culture of the drainage, and appropriate antimicrobial therapy, usually topical, are the keys to management

  • Culture-directed treatment, imaging, and biopsy may be needed to rule out other possibilities when patient does not respond to treatment

  • Patients with facial palsy, vertigo, or other CNS signs should be referred immediately to an otolaryngologist

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Roland  PS,  et al: Chronic suppurative otitis media. http://emedicine.medscape.com/article/859501-overview. Updated March 27, 2015.

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