Otitis Media, Chronic Suppurative

Key Features

• 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

Clinical Findings

• Ongoing purulent ear drainage

• Nonintact TM: perforation or tympanostomy tubes

• May be associated with cholesteatoma

Diagnosis

• Clinical

Treatment

• 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