Chronic suppurative otitis media (CSOM)

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    Chronic bacterial infection of the middle ear with persistent purulent discharge through a perforated tympanic membrane.
    The principal causative organisms are Pseudomonas aeruginosa, Proteus sp, staphylococcus, other Gram negative and anaerobic bacteria.

    Clinical features

    • Purulent discharge for more than 2 weeks, often associated with hearing loss or even deafness; absence of pain and fever
    • Otoscopy: perforation of the tympanic membrane and purulent exudate
    • Complications:
      • Consider a superinfection (AOM) in the case of new onset of fever with ear pain, and treat accordingly.
      • Consider mastoiditis in the case of new onset of high fever, severe ear pain and/or tender swelling behind the ear, in a patient who appears significantly unwell.
      • Consider brain abscess or meningitis in the case of impaired consciousness, neck stiffness and focal neurological signs (e.g. facial nerve paralysis).


    • Remove secretions from the auditory canal by gentle dry mopping (use a dry cotton bud or a small piece of dry cotton wool).
    • Apply ciprofloxacin ear drops until no more drainage is obtained (approximately 2 weeks, max. 4 weeks):

    Children 1 year and over: 3 drops 2 times daily
    Adults: 4 drops 2 times daily

    • Complications:
      • Chronic mastoiditis is a medical emergency that requires prompt hospitalisation, prolonged antibiotherapy that covers the causative organisms of CSOM (ceftriaxone IM for 10 days + ciprofloxacin PO for 14 days), atraumatic cleaning of the ear canal; surgical treatment may be required. Before transfer to hospital, if the patient needs to be transferred, administer the first dose of antibiotics.
      • Meningitis (Chapter 7).