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
- 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
- there may be tinnitus and/or a sensation of pressure in the ear (5)
- 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)
intracranial complications (such as otitic meningitis, lateral sinus thrombosis, and cerebellar abscess)
