Chronic otitis media
Alerts and Notices
Synopsis
CSOM presents with ongoing purulent or mucoid drainage from the middle ear; it is associated with tympanic membrane (TM) perforation and often involves some degree of hearing loss. A cholesteatoma or polyp may be present. It may be unilateral or bilateral. It occurs more often in children but can occur in adults. Other signs and symptoms include otalgia, purulent malodorous discharge, and pruritus. Untreated infection may lead to complications, including irreversible hearing loss, petrositis, meningitis, labyrinthitis, lateral sinus thrombophlebitis, and facial paralysis.
COME, often called glue ear, results from chronic eustachian tube dysfunction. Patients present with complaints of pressure and hearing loss for several weeks or more on the affected side. This is best assessed by pneumatic otoscopy and direct visualization of the TM. Otoscopic findings include an opaque TM with effusion with or without TM retraction or air-fluid levels.
Management of CSOM includes relief of symptoms and prevention of progression to severe and damaging complications. Measures include tympanostomy tube placement and regular aural toilet and quinolone antibiotic ear drops during times of otorrhea. Tympanoplasty without mastoidectomy for noncholesteatomatous chronic otitis media may be called for. Other types of surgery depend on the extent of complications and include removal of infected ear tissue, repair of damaged ear structures, mastoidectomy, ossicular reconstruction, and tympanoplasty.
Pseudomonas, Staphylococcus, Proteus, and Klebsiella are the most common organisms recovered in cultures from patient with CSOM. Repeat cultures can guide antibiotic choices in refractory cases.
Management of COME often includes a formal hearing evaluation to detect hearing loss, tympanostomy tube placement, adenoidectomy, and speech therapy to remediate any speech delays. This is most often seen in the pediatric patient population.
Related topic: acute otitis media
Codes
ICD10CM:H65.20 – Chronic serous otitis media, unspecified ear
SNOMEDCT:
21186006 – Chronic otitis media
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Cholesteatoma
- Otitis externa
- Foreign body
- External auditory canal malignancy (eg, squamous cell carcinoma)
- Middle ear tumor
- Ear trauma
- Petrositis
- Granulomatosis with polyangiitis
- Eosinophilic granuloma
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Management Pearls
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Therapy
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Last Reviewed:11/19/2020
Last Updated:12/09/2020
Last Updated:12/09/2020
Patient Information for Chronic otitis media
Overview
Chronic otitis media is the chronic inflammation of the middle ear. It is characterized by ear pain and some degree of hearing loss. Chronic otitis media may result in flare-ups after infections of the nose or throat or after water enters the middle ear. Chronic otitis media can affect either one or both ears.Who’s At Risk
Chronic otitis media is usually caused by a blockage of the Eustachian tube that connects the ear to the back of the nose, a blast injury from an explosion, or an injury to the ear. Flare-ups are common after colds, ear infections, or when water enters the ear.Signs & Symptoms
The symptoms of chronic otitis media develop gradually over years for some people but may develop as fast as a few months for certain individuals. The symptoms can include:- Hearing loss
- Discharge from the ear
- Ear pain
- Fever
- Facial weakness
- Balance problems
Some people who have chronic otitis media develop cholesteatomas, which are benign growths in the inner ear. The growth of cholesteatomas can damage surrounding structures in the ear and cause long-lasting damage.
Self-Care Guidelines
After surgery (if necessary) monthly checkups with a health care provider is recommended.When to Seek Medical Care
If symptoms of chronic media otitis develop, contact your health care provider.Treatments
Regular aural toilet and quinolone antibiotic ear drops are often given to prevent the progression of the infection. If a health care provider suspects that you may have a cholesteatoma, they may check with an MRI or CT scan. The health care provider may clean the ear to remove discharge. The health care provider may also drain the discharge from the ear to determine the cause of the infection.If severe damage has occurred, surgery is a possible solution. Depending on the damage, the surgery could include repair of the damaged ear, repair of the bone structures in the ear, or removal of superfluous tissue.