ear, nose, and throat disorders
Otitis Media (Chronic Suppurative)
Introduction
Chronic suppurative otitis media is a persistent, chronically draining (>6 weeks), suppurative perforation of the tympanic membrane. Symptoms include painless otorrhea with conductive hearing loss. Complications include development of aural polyps, cholesteatoma, and other infections. Treatment requires complete cleaning of the ear canal, careful removal of granulation tissue, and application of topical corticosteroids and antibiotics. Systemic antibiotics and surgery are reserved for severe cases. Chronic suppurative otitis media can result from Otitis Media (Acute) , eustachian tube obstruction, mechanical trauma, thermal or chemical burns, blast injuries, or iatrogenic causes (eg, after tympanostomy tube placement). Risk is increased in patients with craniofacial abnormalities (eg, Chronic suppurative otitis media may be exacerbated after an upper respiratory infection or by water entering the middle ear through a tympanic membrane perforation during bathing or swimming. Chronic exposure to air pollution and poor hygiene related to living in a low-resource community can also exacerbate symptoms. , resulting in painless, purulent, sometimes foul-smelling Otorrhea . Persistent chronic suppurative otitis media may result in destructive changes in the middle ear (such as necrosis of the long process of the incus) or aural polyps (granulation tissue prolapsing into the ear canal through the tympanic membrane perforation). Aural polyps are a serious sign, almost invariably suggesting cholesteatoma. In immunocompromised patients (eg. patients with diabetes), is an epithelial cell growth that forms in the middle ear, mastoid, or epitympanum. Lytic enzymes, such as collagenases, produced by the cholesteatoma can destroy adjacent bone and soft tissue (including the tympanic membrane). The cholesteatoma is also a nidus for infection; Purulent Labyrinthitis , facial paralysis, or 