ear, nose, and throat disorders
Otitis Media (Chronic Suppurative)
Treatment of Chronic Suppurative Otitis Media
Topical antibiotic drops Removal of granulation tissue Surgery for cholesteatomas Dry ear precautions are required unless patients are being treated with antibiotic ear crops. Dry ear precautions include occluding the external canal (eg, using a cotton ball lathered with petroleum jelly) while bathing and showering and avoiding swimming. Four to 5 drops of topicalciprofloxacin(orofloxacin) solution are instilled in the affected ear 2 times a day for 10 to 14 days. Ear drops that contain aminoglycosides (eg,neomycin,tobramycin) or polymyxin should not be prescribed for patients with a perforated tympanic membrane or a tympanostomy tube because of potential ototoxicity. When granulation tissue is present, it may be removed with microinstruments or cauterization withsilver nitratesticks.Ciprofloxacinanddexamethasoneis then instilled into the ear canal for 7 to 10 days. Sometimesciprofloxacinanddexamethasoneare given for 10 to 14 days without debridement. When granulation tissue persists or continues to recur in spite of adequate local treatment, a biopsy to rule out a neoplasm should be done. Severe exacerbations require systemic antibiotic therapy withamoxicillin250 to 500 mg orally every 8 hours for 10 days or a third-generation cephalosporin; if needed, antibiotics are subsequently modified based on culture results and response to therapy. Tympanoplasty is indicated for patients with marginal or attic perforations and chronic central tympanic membrane perforations. A disrupted ossicular chain may be repaired during tympanoplasty as well. Cholesteatomas must be removed surgically, and the middle ear must be reconstructed. Because recurrence is common, reconstruction of the middle ear is usually deferred until a 2nd-look operation (using an open surgical approach or a small-diameter otoscope) is done 6 to 12 months later. 