Chronic Otitis Media - Definition, Symptoms, Complications and Treatment

Chronic Otitis Media

Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media

Chronic Otitis Media (COM) is the term used to describe a variety of signs, symptoms, and physical findings that result from the long-term damage to the middle ear by infection and inflammation. This includes the following: perforation of the eardrum, scarring or erosion of the small, sound conducting bones of the middle ear, chronic or recurring infected drainage from the ear damage to surrounding structures such as the balance or hearing organs of the inner ear, the facial nerve, or the brain and its coverings, known as the meninges.

Chronic Otitis Media - Definition

Definition of Chronic Otitis Media
Definition of Chronic Otitis Media

Chronic Otitis Media (COM) or Chronic Suppurative Otitis Media (CSOM) is defined as a persistent ear infection (greater than three months in duration) in the presence of a tympanic membrane perforation and continuous or recurrent ear drainage.

The tympanic membrane is perforated in CSOM. If this is a tubotympanic perforation, it is usually 'safe', whilst atticoantral perforation is often 'unsafe'.

Safe or unsafe depends on the presence of cholesteatoma:

• Safe CSOM is CSOM without cholesteatoma. It can be subdivided into active or inactive depending on whether or not infection is present.
• Unsafe CSOM involves cholesteatoma. Cholesteatoma is a non-malignant but destructive lesion of the skull base.

Chronic Otitis Media - Symptoms

Symptoms of Chronic Otitis Media
Symptoms of Chronic Otitis Media

A chronic ear infection can cause milder symptoms than an acute ear infection. Symptoms may affect one or both ears and may be constant or come and go. 

Typically, a conductive hearing loss is also present. If left untreated, CSOM can result in serious complications such as mastoiditis, facial nerve dysfunction, cholesteatoma formation, dizziness and intracranial disease.

Signs include:
• a feeling of pressure in the ear
• mild ear pain
• fluid draining from ears
• low fever

Chronic Otitis Media - Complications

Complications of Chronic Otitis Media
Complications of Chronic Otitis Media

Complications of CSOM are rare but potentially life-threatening.

Intratemporal complications include:

• Petrositis
• Facial paralysis
• Labyrinthitis

Intracranial complications include:

• Lateral sinus thrombophlebitis
• Meningitis
• Intracranial abscess

Sequelae include:

•Hearing loss
•Tympanosclerosis

Chronic Otitis Media - Treatment

Treatment of Chronic Otitis Media
Treatment of Chronic Otitis Media

Patients with CSOM that is unresponsive to topical and/or systemic medical therapy with appropriate aural toilet and control of granulation tissue require surgery.

Current goals for surgery for chronic ear disease include a dry, safe ear and the preservation of the normal structure and functioning to the greatest extent possible.


Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media
Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media


In patients with CSOM without cholesteatoma, surgery is considered if the perforation is persistent and long-standing and causes clinical symptoms, such as recurrent ear discharge and hearing loss. The age, general physical condition, fitness for general anesthesia, and coexisting diseases of the patient also play an important role in considering surgery.

General indications for surgery are as follows:

• Perforation that persists beyond 6 weeks
• Otorrhea that persists for longer than 6 weeks despite antibiotic use
• Cholesteatoma formation
• Radiographic evidence of chronic mastoiditis, such as coalescent mastoiditis
• Conductive hearing loss


Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media
Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media


For patients with early or mild CSOM cholesteatoma, aural toilet and repeated suction clearance of the ear with watchful expectancy may be performed; for patients with advanced disease, exploration of the mastoid and tympanoplasty is recommended.

Contraindications (relative and absolute) to surgery for tubotympanic disease are as follows:

• Surgery on the only hearing ear
• Poor general physical condition, old age, or debility that makes general anesthesia risky
• Patients unwilling to undergo surgery
• Surgery on patients with unilateral vestibular ablation
Contraindications to surgery for atticoantral disease are as follows:
• Early or mild cholesteatoma amenable to aural toilet
• Patients who are severely ill and those with complications secondary to cholesteatoma, such as a brain abscess (drainage of the brain abscess and intravenous administration of antibiotics should be considered first)

Source links:

  • Kronik Süpüratif Otitis Media Hastalığının Tanımı

  • Chronic Suppurative Otitis Media Treatment & Management

  • Ear infection - chronic: MedlinePlus Medical Encyclopedia

  • Chronic Suppurative Otitis Media | Doctor | Patient.co.uk

  • Middle Ear Infection (Otitis Media) Symptoms, Home Remedies ...

  • Diagnosis and Treatment of Otitis Media - American Family Physician

  • Fact Sheet: Chronic Otitis Media (Middle Ear Infection) and Hearing ...

  • Chronic Suppurative Otitis Media - Pediatrics in Review

  • Ear Infection - Chronic Treatment - Ear Infection - Chronic Health ...

  •  

    Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

    Private Office:
    Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
    Appointment Phone: +90 212 561 00 52
    E-Mail: muratenoz@gmail.com
    Mobile phone: +90 533 6550199
    Fax: +90 212 542 74 47


     

     
    

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