Chronic Suppurative Otitis Media (CSOM) is a repeated infection in the middle ear or subsequent problems from such an infection. The infection can be active or inactive. Usually there is a hole in the eardrum, discharge of pus and an infection in the ear. Most of the time, this condition is not painful, although it can be at times. It can also lead to formation of a cyst, called a cholesteatoma, which destroys the ear bones and other parts of the ear as it grows beneath the remaining eardrum. The long-term complications from this type of infection can result in damage to the ear bones and result in hearing loss.
What Are The Risk Factors?
- Multiple episodes of ear discharge
- Living in crowded conditions
- Being a member of a large family
- Children attending daycare
- Craniofacial anomalies have increased risk: cleft lip or palate, down’s syndrome, choanal atresia and microcephaly
What Are The Symptoms Of CSOM?
- CSOM occurs with a chronically draining ear (>2 weeks), with a possible history of recurrent Acute Otitis Media (AOM), traumatic perforation, or insertion of ventilation tube in the ear
- The ear discharge can also occur without ear pain or fever
- Fever, persistent severe headache, giddiness and ear pain should prompt urgent referral to avoid complications
- Hearing loss is common in the affected ear
What Is The Treatment For CSOM?
If there is a hole in the eardrum, it is useful to try and prevent water from entering the ear canal and getting through the hole in the eardrum. Water coming in through that hole will often lead to infection from the outside and recurrent discharge. The use of the ear plugs provided at the clinic is usually quite effective in preventing this and is highly recommended when showering or swimming.
Medical treatments are used to decrease inflammation and swelling in the ear prior to surgical intervention.
- It is often necessary to use various antibiotic drops as prescribed by the doctor
- Complete course of antibiotic as prescribed
- It is necessary to keep the ear dry. Keep a Vaseline soaked cotton wick in the ear while taking bath
- In case of upper respiratory tract infection like running nose or sore throat, consult a doctor
Surgical treatment varies based on the extent of the condition.
- Tympanoplasty: This involves reconstruction of the eardrum and/or the small bones in the middle ear after removal of the disease. An incision is made in the crease behind the ear and some of the chewing muscle near the ear is used to reconstruct the eardrum. This can be done using a general anesthetic or a local anesthetic. A fluffy dressing is done over the ear for one week.
- Mastoidectomy: Mastoid is the cavity behind the ear that is connected to the middle ear. Often, a small skin cyst develops in the eardrum and tracks back through the middle ear into the mastoid cavity. This is called a cholesteatoma. In this case and in cases where there is severe infection in the middle ear, it is necessary to enter the mastoid cavity and treat the disease. The small honeycomb air cells in the bone of the mastoid are drilled and the cholesteatoma is removed, and other diseased tissues are also removed.
- Mastoid cavity: In some cases, disease or previous surgery destroys the ear canal wall, separating the mastoid cavity from the ear canal. At this time, it may be feasible to reconstruct the ear canal wall. However, sometimes it is not possible. In such an event, it is necessary to create a common cavity between the mastoid and the ear canal. The opening to the ear canal will be a good bit larger and this will be noticeable. The resultant cavitywill generally not make any difference in hearing as compared to a normal ear canal. Sometimes, it is also necessary to create this cavity when the cholesteatoma or cyst is very extensive and has resulted in complications.
What Is The Goal Of The Surgery?
- To eliminate the infection and create a dry, healed ear
- To improve the hearing. Sometimes, the disease is such that it precludes any attempts to reconstruct the hearing mechanism and the efforts are concentrated on just eliminating the infection