Chronic Otitis Media - Definition, Symptoms, Complications and Treatment

Chronic Middle Ear Infection and Perforated Eardrum

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

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 suppurative otitis media (CSOM) is a chronic otitis media and inflammation of the mastoid bone, which is accompanied by a persistent ear canal hole, in which the inflammatory discharge from the middle ear is discharged, manifested by the symptoms of hearing loss and ear discharge. Usually, chronic ear discharge lasts for more than 6-12 weeks. There are two different forms accompanied by cholesteatoma (inflammation foci arising from skin cells behind the eardrum, middle ear) and without cholesteatoma. The clinical history of both conditions can be very similar. The treatment plan for CSOM with cholesteatoma always requires surgical treatment for the middle ear and mastoid bone along with medical therapy as an adjunct.

Chronic Otitis Media - Symptoms

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. The main symptoms of the disease are hearing loss and ear discharge. Diagnosis can be made by ear examination and ear tomography. Audiometric hearing tests are also requested in patients planned for surgery.

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

In this disease, one or more of the following symptoms can be seen in varying amounts depending on the severity of the disease:

- Ear discharge (there may be an inflammatory, transparent or thick discharge, a foul-smelling ear discharge may be seen in patients with cholesteatoma)

- Hearing loss

- Dizziness

- Facial paralysis (it is a rare complication that can be seen mostly in the presence of cholesteatoma and long-term diseases)

Although pain and fever are generally seen in acute otitis media; not seen in conical otitis media. When complications develop (such as meningitis, brain abscess, large vessel inflammation in the head and neck), fever and pain may occur together.

Chronic Otitis Media - Complications

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

Petrositis (inflammation of the petrous bone)

When the infection extends beyond the middle ear and mastoid bone margins, it can reach the petrous apex and cause petrosite. Gradenigo syndrome, which consists of pain behind the eye, ear discharge, and paralysis of the abducens nerve (paralysis of the nerve that turns the eye outward) may occur. A tomography scan of the head and temporal bone is useful to define the extent of the disease and determine its spread in the head. Treatment consists of petrozectomy surgery and the use of systemic antibiotics.

Facial paralysis

Facial paralysis can be seen in CSOM patients with or without cholesteatoma. Removal of the diseased mucosa, removal of granulation tissue and inflammations by mastoidectomy should be performed immediately.

Labyrinthitis (inner ear inflammation)

It occurs when the infection spreads to the inner ear. This spread can occur quickly or over a long period of time. Infection can spread to the inner ear by infection through one of the round window, oval window or semicircular canals.

Labyrinthitis is classified in 4 ways:

Acute serous: early stage of dizziness and hearing loss

Acute suppurative: maturation period of inflammation with nausea, vomiting, severe hearing loss, tinnitus and dizziness

Chronic: a long period when damage to the inner ear due to inflammation becomes permanent

Labyrinth sclerosis: the period in which there are structural changes and healing foci in the inner ear structures, fibrous tissue and new bone formation appear in the labyrinth structures.

In the beginning, nystagmus (involuntary movement of the eyes) was observed in patients with the rapid component hitting the affected ear; After the membranous labyrinth destruction is complete, nystagmus that hits the affected ear occurs. Treatment includes aggressive surgical debridement (including labyrinthectomy) and antibiotic therapy to prevent serious intracranial complications such as meningitis or encephalitis. It is appropriate to use broad spectrum antibiotics that can pass into the CSF (cerebrospinal fluid). Antibiotic treatment can be changed according to the culture and antibiogram results.

Chronic labyrinthitis is characterized by dizziness, tinnitus, and hearing loss. Most often, the infection reaches the inner ear through the lateral canal (outer semicircular canal). Treatment is mastoidectomy, appropriate medical treatment according to the culture - antibiogram result.

Lateral sinus thrombophlebitis (inflammation of the vein)

When the infection reaches the veins such as the sigmoid or lateral sinus extending along the mastoid bone, the emergence of infected thrombi, even; These embolisms detached from the intra-vascular inflammation foci may cause end vascular occlusion and cause tissue death (embolism may occur due to septic distal infarctions). Patients present with mental status changes, seizures and fever. After mastoidectomy surgery and surgical excision of thrombi, treatment is performed by arranging antibiotic treatment according to the culture result.

Meningitis

Meningitis occurs as a result of the direct or hematogenous spread of infection. If meningitis is suspected, cerebrospinal fluid (CSF) is taken with lumbar puncture and broad-spectrum antibiotic treatment is started according to the result of culture and sensitivity assessment. After the patient is stabilized, the inflamed areas in the middle ear are surgically cleaned in the form of mastoidectomy operations.

Intracranial abscesses

Intracranial abscesses in the form of extradural (located on the outside of the dura mater, which is the brain membrane), subdural (located in the lower part of the dura mater) or parenchymal (belonging to the brain tissue) abscesses can be seen.

A patient with an extradural abscess may present with signs and symptoms of meningitis or may be asymptomatic. Imaging methods should be used for the diagnosis of intracranial abscess and when an intracranial abscess is diagnosed, the abscess should be drained together with the neurosurgeon.

Patients with subdural abscess often present with meningeal findings, seizures, and hemiplegia (paralysis in one half of the body). The standard approach is to consult the neurosurgeon to the patient, to apply imaging methods, to evacuate the abscess and to start antibiotic treatment. After the patient is stabilized, areas of infection in the middle ear, which are the focus of infection, are surgically cleaned.

Cerebral abscesses can be seen when the infection spreads through the tegmen tympani or tegmen mastoideum to the temporal lobe of the brain or to the cerebellum (cerebellum). Brain abscess may be "silent" initially. When intracranial dissemination is suspected in imaging methods, the abscess is drained by the neurosurgeon and antibiotic treatment is initiated.

Chronic Suppurative Otitis Media (CSOM)

Chronic suppurative otitis media is a persistent drainage (discharge) of the middle ear that lasts longer than 6-12 weeks, accompanied by a perforated eardrum. Chronic aspiration may occur with cholesteatoma or cholesteatoma, and both cases may have a very similar clinical history (cholestetaom or cholesteatoma, a tumor of the epithelial cells containing bone epithelial cells that can dissolve bone tissue by acting as a tumor. In chronic suppurative otitis media, it may be difficult to treat the hole in the tympanic membrane, in which the discharge of the chronic infection.

Chronic suppurative otitis media may begin with an acute infection attack. The pathophysiology of CSOM begins with irritation of the middle ear mucosa and then inflammation. Inflammatory response is caused by mucosal payment. After continued inflammation, mucosal ulceration leads to disintegration of the epithelial layer. Inflammation, ulceration, infection, and granulation can lead to various complications of KSOM, resulting in the disappearance of the surrounding bony margins that can continue the cycle of tissue formation.

Microorganisms Causing Chronic Suppurative Otitis Media (KSOM) Disease

Pseudomonas aeruginosa, Staphylococcus aureus, Proteus species, Klebsiella pneumoniae and diphthroids are the most common bacteria found in examinations of chronic ear discharge. Anaerobic (breeding in the presence of oxygen) bacteria and fungi can develop simultaneously with aerobic bacteria (that grow in the presence of oxygen) in a symbiotic relationship. P aeruginosa is the most common organism detected in chronic ear discharge. In the last few years, various researchers have identified Pseudomonas in 48-98% of CSOM patients. These mixed microbial factors that can be seen in the disease reduce the effectiveness of medical treatment.

How Does Chronic Suppurative Otitis Media (CSOM) Disease Occur?

Chronic suppurative otitis media (CSOM) usually occurs following an acute infection. CSOM begins to occur with the recurrent inflammation process in the mucosa following recurrent irritation of the middle ear mucosa and the emergence of inflammation of the middle ear mucosa as a result. Inflammatory response creates mucosal edema. Ulceration of the mucous membranes and disruption of the epithelial covering occur due to ongoing inflammation. In this process, granulation tissue and polyps may occur in the middle ear cavity. At the end of the cycle of inflammation, ulceration, infection and granulation tissue formation, the surrounding bone structures may be damaged and as a result, various complications may occur due to CSOM.

Causes of Chronic Suppurative Otitis Media (CSOM) Disease

CSOM occurs as a result of a chronic inflammatory process that develops after permanent hole formation in the eardrum due to traumatic causes, acute infection or surgical procedure (iatrogenic).

It is argued that the passage of bacteria in the outer ear canal to the middle ear through the hole in the eardrum into the middle ear plays a role in the emergence of chronic middle ear infection. Some sources report that pathogenic microorganisms enter the middle ear with a reverse current (reflux) from the eustachian tube. Data supporting this theory are insufficient. It is more widely accepted that pathogenic bacteria mostly come from the external auditory canal. Supporting this theory, there is a risk of developing CSOM in 1-3% of patients who have a ventilation tube in the eardrum.

The risk of developing CSOM is increased if:

- Recurrent attacks of acute otitis media (acute otitis media)

- Living in crowded environments

- Living in day care centers

- Being a member of a crowded family

Apart from these, controversial factors associated with CSOM:

- Passive smoking

- Nutrition with breastfeeding in children

- Low socioeconomic status

- Having frequent upper respiratory tract infections

- Presence of craniofacial anomalies

- Cleft palate

- Cleft lip

- Down syndrome

- Cri du Chat syndrome

- Choanal atresia

- Microcephaly

- All diseases and conditions that may affect the functions of the eustachian tube.

Dagnosis of Chronic Otitis Media

The diagnosis of CSOM requires a perforated tympanic membrane. These holes may be traumatic after tube insertion or after decompression of acute otitis media through a tympanic perforation.

Risk Factors of Chronic Otitis Media

The risk of developing CSOM increases with the following conditions:

- History of multiple attacks of acute otitis media
- Living in crowded conditions
- Exposure to cigarette smoke or smoking
- Presence of craniofacial anomalies (cleft palate and lip, Down Syndrome, Cri Du Syndrome, Koanal Atresia, DiGeorge Syndrome, microcephaly)
- Low socioeconomic status
- Frequent upper respiratory tract infection
- Nasal obstruction (adenoid hypertrophy, septum deviation, turbinate hypertrophy, nasal polyps ...)
- Continue to day care facilities

What is Mastoiditis?

Mastoit Bone lava, which is located just behind the auricle and behind the middle ear and containing the sacs like the inner lung, is defined roughly as the "mastodit". The definition of mastoiditis involves all the inflammation processes of mastoid air cells of the temporal bone. Since the mastoid is adjacent to the middle ear and connects with the anatomical clefts between the middle ear and the mastoid, almost every child or adult may have acute otitis media (AOM) or mastoidititis in chronic otitis media. In most cases, the symptomatology of the middle ear is predominant (eg, fever, pain, conductive hearing loss), and the disease within the mastoid is not considered a separate entity.

Acute Mastoiditis

Acute mastoiditis is associated with AOM. In some patients, the infection spreads beyond the cleft mucosa in the middle ear and causes osteitis (bone inflammation and bone inflammation) in the periosteum in the mastoid air cell system or mastoid process, either directly through the cortex, or indirectly through the emissary vein, causing mastoidity.

Chronic Mastoiditis

Chronic mastoiditis is mostly associated with chronic suppurative otitis media and especially cholesteatoma formation. Cholesteatomas are benign populations of the squamous epithelium that can alter and alter the normal structure and function of the surrounding soft tissue and bone. This destructive process is accelerated in the presence of active infection by secretion of osteolytic enzymes by epithelial tissue. As seen in the above photo and at the end of the link, in the patient with chronic otitis media, the ear tomography (temporal bone CT) of the patient revealed a soft tissue mass filling the left mastoid bone cells, and the middle ear destroyed the ossicular chain.

Differences Between Acute Otitis Media and Chronic Otitis Media

Both are terms used to mean otitis media. The differences between acute and chronic otitis media can be summarized as follows:

The word acute, as the name suggests, refers to diseases and conditions that have emerged in a short time. In other words, the presence of infection in the middle ear for less than 3 weeks can be called acute otitis media. Infection in the middle ear between 3 weeks and 3 months is called subacute otitis media. Infection in the middle ear for more than 3 months is called chronic otitis media. Chronic suppurative otitis media is defined as the presence of infection in the middle ear for more than 3 months and the presence of inflammatory discharge from the middle ear to the outer ear canal.

- comparing symptoms, acute otitis media is typically an upper respiratory tract infection followed by middle ear infection with signs of infection such as pain in the ear, hearing loss and fever. It is usually seen in children between the ages of 6 months and 6 years, and families state that their children first have a viral upper respiratory tract infection, then earache and other symptoms appear. Chronic otitis media, on the other hand, usually causes complaints with a previous perforation area in the eardrum and hearing loss and occasional inflammatory discharge in the ear. As in acute otitis media, symptoms of fever, weakness, malaise and ear pain are usually absent. In patients with chronic otitis media, complications such as spread of the infection to the surrounding tissues and mastoiditis can be considered when pain occurs around the ear and ear. In other words, ear pain in chronic otitis media is not an expected finding.

- In acute otitis media, it usually heals when the healing is complete, even if a hole has appeared in the eardrum, it closes on its own. Sometimes patients may express that symptoms such as fever and fatigue disappear when the tympanic membrane is perforated and the inflammation discharges outward. If there is no water-to-water contact with the ear, the hole that occurs usually heals by closing within a few weeks. After acute otitis media, serous fluid can be found in the middle ear for a few weeks during the healing period, and then when the hole in the eardrum is closed, the middle ear and eardrum can be evaluated as normal on examination. In chronic otitis media, the perforation edges of the eardrum are usually epithelialized and the hole is permanent because it is a chronic process, even if the discharge decreases or disappears with medical treatment; When the hole in the eardrum is permanent, it can still be noticed during the examination.

- When recovery is complete after acute otitis media, hearing loss is usually not observed and the patient's hearing returns to normal threshold values. In chronic otitis media, since the process is usually present for years, structural changes in the ossicles in the middle ear and damage to the cells in the inner ear can be found together due to the long-term presence of inflammatory products. In other words, even if the ear discharge goes away with medical treatment in chronic otitis media, hearing levels may not return to normal values ​​and progressive hearing loss may occur in patients.

- While simple otoscopic or microscopic ear examination is sufficient in acute otitis media, additional imaging such as hearing test and computed tomography may be required in chronic otitis media.

Chronic Otitis Media and Mastoiditis - Treatment

Treatment of chronic otitis media

General treatment principles in patients with chronic otitis media are inflammation therapy and hearing protection. It is important for people with this disease to protect their ears from water contact. For the treatment of inflammation, topical drip treatment and oral antibiotic treatment are applied. Surgical treatment involves tympanic membrane surgery (myringoplasty and tympanoplasty) and mastoidectomy operations in patients with inflammatory islets trapped in the middle ear or cholesteatoma.

The purpose of CSOM treatment is to prevent the spread of the infection that may occur due to the disease to structures such as the brain, facial nerve and neck vessels, in other words to control the infection. The second is the restoration of hearing. The results in terms of hearing and infection are generally satisfactory in patients with simple ear holes without cholesteatoma. If there is cholesteatoma, widespread infection residues in the middle ear, and resorption of the ear ossicles in patients who have not received medical treatment and are not followed-up, the size of the surgery to be performed is greater and the success may decrease in terms of hearing results.

It is reported that after a simple eardrum surgery (tympanoplasty, myringoplasty operations), if there is no problem in the middle ear and inner ear structures, hearing generally increases, and ear discharge that occurs when water escapes disappears. In patients with cholesteatoma, mastoidectomy operations, as well as mastoidectomy operations, and in cases with damage to the ossicular chain, reconstruction of the ossicular chain (ossicular chain reconstruction, ossiculoplasty) are also required. You can find detailed information about mastodectomy surgeries and tympanoplasty surgeries used in CSOM treatment from the links below.

It is especially important to treat underlying diseases that facilitate chronic middle ear inflammation before ear surgery.

For example, termination of smoking, treatment of nasal congestion ...

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. In case of chronic mastoiditis with chronic otitis media, surgical procedures involving surgical procedures for the middle ear ossicles, surgical procedures for the eardrum and cleaning of mastoid cells in the middle ear, cleaning of the mastoid cells and, if possible, reconstruction of the auditory surgery, are planned.







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


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)

Videos about the subject and descriptions:

Bad Smelling Inflammatory Ear Stream Can Be a Sign of "Cholesteatoma"!

Cholesteatoma is a rare abnormal collection of skin cells within the ear. By acting like a tumoral tissue, it has properties that can damage the surrounding bone tissue and the surrounding brain membrane, brain and facial nerve. It is composed of encrusted ball-shaped, skin cells. Cholesteatomas usually develop as cysts or pouches that shed old skin layers that accumulate in the middle ear. Over time, it may increase the size of the cholesteatoma and break down the sensitive bones in the middle ear and cause hearing loss.

Mastoidectomy Operation Video - 1

Mastoidectomy Operation Video - 2

The general principles of treatment in patients with chronic otitis media, inflammation treatment and hearing protection. It is important for people with this disease to protect their ears from contact with water. Topical drop therapy and oral antibiotic therapy are applied for the treatment of inflammation. In the surgical treatment, mastoidectomy operations are performed in patients with eardrum surgeries (myringoplasty and tympanoplasty) directed to the hole in the eardrum and in patients with inflammation islets or cholesteatoma trapped in the middle ear.

About The Mastoidectomy Operation

Cortical mastoidectomy or simple mastoidectomy operation

Cortical mastoidectomy or simple mastoidectomy (also known as Schwartze procedure) is carried out without affecting the middle ear in the removal of mastoid air cells. This is usually done for inflammation of the mastoid bone. In cases where medical treatment is not effective, it is a surgical procedure to remove inflamed bone tissue with an incision made behind the ear. Because of the widespread use of antibiotics in this surgery, there is rarely a need for it today.

Modified radical mastoidectomy operation

Modified radical mastoidectomy is an operation designed to remove only the inflamed mastoid bone and external ear canal wall if the cholesteatoma is not spread to the middle ear, the head of the malleus bone or the body of the incus bone. Channel wall down can be used in the same sense as mastoidectomy. This procedure is usually performed on the ear, which is the only hearing and cholesteatoma. Since all or some of the structures in the middle ear are intended to be preserved; is a surgical procedure in which hearing is protected.

Radical mastoidectomy operation

In radical mastoidectomy, all of the structures in the middle ear and the outer ear canal are removed, and the mastoid bone and the middle ear are converted into a single cavity. In other words, in radical mastoidectomy operation, the hearing is not preserved; In the modified radical mastoidectomy, it is tried to protect the hearing structures. In other words, this procedure is a procedure involving simple mastoidectomy and radical mastoidectomy, considering the magnitude of the procedure.

Again, as with simple mastoidectomy and radical mastoidectomy, the skin is removed with a retroauricular incision made behind the ear. The bone area of the mastoid is removed by a lap and a microscope. The outer ear canal wall between the middle ear and the mastoid bone, which is called a "bridge", is lowered. Cholesteatoma is removed. Damage to the tympanic membrane. The middle ear structures are preserved. The damaged area of the eardrum is repaired. The cavity is placed in a spongostan. The operation is terminated by placing a buffer in the outer ear canal.

Important Information for Patients With Chronic Otitis Media

Patients with chronic otitis media disease and perforation of the eardrum should be careful about the following:

- Please do not get water inside your ear. Since the eardrum is perforated, infection in the middle ear may cause structural changes in the ossicles and mucous membranes, and exacerbate the disease due to infections. Unnecessarily, it can cause both a decrease in your hearing levels and a more complicated surgical procedure in the future. It is important to place vaseline cotton in the outer ear canal during bathing or to place a plug that protects the outer ear canal from water. Swimming in the pool and sea during the holiday period can cause serious ear infections. Even if you use a tight bonnet or earplug; When you enter the pool and sea, serious ear infections may begin. Please take due care in this regard.

- Do not use systems such as sinus rinse, neti pote or nasendueche that irrigate the nose with high volume. Since your eardrum is perforated, water may enter your ear through the Eustachian tube and infections may begin.

- Do not use glycerin-derived drops that soften earwax or solutions containing oxygenated water to remove earwax without consulting your doctor. Since your eardrum is perforated, direct instillation of non-sterile drops into the middle ear can lead to the onset of infection.

- If inflammatory discharge from the ear has started, please consult an otolaryngologist and do not accept this as a normal situation. Early medical treatment can reduce the likelihood of inflammatory complications.

- If your hearing is gradually decreasing in your ear, or if there is a foul-smelling discharge, consult an ENT specialist. Sometimes cholesteatoma may occur. Especially in patients with chronic otitis media who remain unfollowed and untreated, the possibility of infection-related complications may increase.

- if you feel unilateral lack of movement on your face, especially on the side with chronic otitis media, if you feel signs of facial paralysis, please consult an ent doctor as soon as possible.

- Please do not put natural or herbal ingredients such as onion juice or garlic juice, which you have only heard on the internet, into your ear without consulting your doctor. Patients with intact eardrums can drip vinegar or natural lemon juice for ear itching, but it is not appropriate for patients with chronic otitis media and perforation of the eardrum to drip any drops in their ears without consulting a doctor.

Patients with chronic otitis media can stay uneventful for years if they protect their ears from water contact and are followed by an otolaryngologist. It is ideal for your treatment and your follow-up to be done by an ENT specialist.

Source links:

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