Chronic Suppurative Otitis Media (CSOM) can be:
- a tympanic membrane perforation that does not heal and causes ongoing discharge or
- due to cholesteatoma, a ‘collection of skin in the wrong place’ in the middle ear cavity.
Cholesteatoma.
This is particularly rare (about 9 per 100,000) and presents as:
- Recurrent infection, often very smelly, often painless without other symptoms
- Initial response to topical / oral treatment
- short lived, frequent relapses
Complications:
- Hearing loss (conductive or sensorineural)
- Spread of infection (mastoiditis, meningitis, cerebral abscess)
- Facial nerve Palsy
Examination – otoscopy:
- Copious smelly discharge, often little else to see
- Might see crusty discharge in attic or squamous debris in canal
- Or unusual appearance – may not have seen before
- CHECK for potential complications (see above).
Who to refer:
Please refer where topical and oral antibiotics have been tried and thee
Please refer where there is no improvement, or recurrence, despite appropriate management (topical AND oral antibiotics).
How to refer:
- Refer to ENT
REFER URGENTLY (OR SAME DAY) WHERE THERE ARE COMPLICATIONS.
Initial management is with topical and oral antibiotics.
