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Disease Details

EAR DISCHARGE / CSOM

Chronic Suppurative Otitis Media (CSOM)

Chronic suppurative otitis media (CSOM), (also often referred to as chronic otitis media (COM))

  • is a chronic inflammation and infection of the middle ear and mastoid cavity, characterized by ear discharge (otorrhoea) through a perforated tympanic membrane


 

  • no universally accepted definition of CSOM. Some define CSOM in patients with a duration of otorrhoea of more than two weeks but others may consider this an insufficient duration, preferring a minimum duration of six weeks or more than three months (1)
    • some include diseases of the tympanic membrane within the definition of CSOM, such as tympanic perforation without a history of recent ear discharge, or the disease cholesteatoma (growth of the squamous epithelium of the tympanic membrane)
      • if considering two types of chronic suppurative otitis media then may be considered as:
        • safe, tubotympanic or mucosal disease:
          • there is a perforation of the pars tensa, and local destruction doesn't occur
        • unsafe, atticoantral or bony disease:
          • there may be a cholesteatoma developing in the pars flaccida and the posterosuperior portion of the pars tensa. This may lead to local destruction of bone

Clinical features of CSOM include:

  • predominant symptoms of CSOM are ear discharge and hearing loss
    • ear discharge can be persistent or intermittent - discharge is often visible and odorous (3) and hence leads to social embarrassment
    • most patients with CSOM experience temporary or permanent hearing loss with average hearing levels typically between 10 and 40 decibels
      • hearing loss can have an impact on speech and language skills, employment prospects, and on children's psychosocial and cognitive development, including academic performance (2)
      • there may be tinnitus and/or a sensation of pressure in the ear (5)
      • CSOM can also progress to serious complications in rare cases (and more often when cholesteatoma is present):
        • extracranial complications (such as mastoid abscess, postauricular fistula, and facial palsy) or

intracranial complications (such as otitic meningitis, lateral sinus thrombosis, and cerebellar abscess)