A Family Doctor's Tale - CHRONIC SUPPURATIVE OTITIS MEDIA

DOC I HAVE CHRONIC SUPPURATIVE OTITIS MEDIA

Chronic Suppurative Otitis media is chronic inflammation and infection of the middle ear which can result in a persistent foul smelling ear discharge and hearing loss.

Chronic Suppurative Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear and is caused by a perforation of the eardrum and recurrent infection of the middle ear.

The ear drum perforation is usually due to previous injury to the eardrum or severe infection of the middle ear.

Part of the skin of the ear will grow into the bone of of the middle ear forming what is known as a cholestestoma. This can grow causing chronic ear discharge and hearing loss.

The Causes of Chronic Suppurative Otitis media are:
Bacterial infections:

1.Streptococcus pneumoniae

2.Haemophilus influenzae

3.staphylococcus aureus

4.Moraxella catarrhalis, a gram-negative diplococcus.

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.common cold.

2.measles

Chronic Suppurative  otitis media occurs following acute otitis media with chronic infection of the middle ear and ear perforation.

The complications of  Chronic Suppurative Otitis media are:
1.mastoiditis

2.labrynthitis

3.facial nerve palsy

4.meningitis,

5.brain abscess,

6.febrile seizures.

7.death if a severe infection goes untreated long enough

The Symptoms and signs of Chronic Suppurative Otitis media are:
1.Recurrent ear discharge from infection of the middle ear and pus escaping through a perforated ear drum


2. Recurrent earache  from the collection of pus and infection in the middle ear


3.hearing loss from perforation of the eardrum and erosion of the ossicles of the middle ear


Signs:

1.Ear drum usually has a perforation


2.Pus present in the external canal


3.cholestestoma present in the middle ear


4.facial paralysis


The diagnosis of  Chronic Suppurative Otitis media is made on the basis of:
1.Inflamed ear drum with  perforation and purulent discharge.

2.Culture and sensitivity of pus swab from the ear discharge


3.X-rays or MRI of the mastoid air cells and temporal bones


5.Audiogram for hearing loss

The treatment of Chronic Suppurative Otitis media is based on:


Medical:

1. Antibiotics both oral and topical are given especially if the culture showed bacterial infections.

2. pain may be treated with paracetamol or analgesics


3.Antihistamines may be given for stuffed nose


Surgery:

1.Myringoplasty -Puncture of bulging ear drum if painful and aspiration of pus or fluid in the middle ear.

2.Tympanoplasty for eardrum whose perforation does not heal.

3.Mastoidectomy to remove cholesteatoma(growing of skin into middle ear cavity) in chronic otitis media with mastoiditis.

The prognosis of Chronic Suppurative Otitis media is:
Healing with appropriate treatment is generally good but recurrence is quite common.

Ear drum perforation can be closed with surgery.

Hearing loss may still be present in spite of treatment.


The Preventive measures for Otitis media are:
Avoid chronic infection of the ear


Avoid swimming and diving.

Proper ear hygiene.