{"id":22780,"date":"2025-02-04T14:05:46","date_gmt":"2025-02-04T14:05:46","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=22780"},"modified":"2025-02-04T14:24:42","modified_gmt":"2025-02-04T14:24:42","slug":"chronic-suppurative-otitis-media-cholesteatoma","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/earinfectionsinchildren\/chronic-suppurative-otitis-media-cholesteatoma\/","title":{"rendered":"Chronic Suppurative Otitis Media \u00a0\/ Cholesteatoma"},"content":{"rendered":"\n<p>Chronic Suppurative Otitis Media (CSOM) can be:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>a tympanic membrane perforation that does not heal and causes ongoing discharge or<\/li>\n\n\n\n<li>due to cholesteatoma, a \u2018collection of skin in the wrong place\u2019 in the middle ear cavity.<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Cholesteatoma.<\/u><\/strong><\/p>\n\n\n\n<p>This is particularly rare (about 9 per 100,000) and presents as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Recurrent infection, often very smelly, often painless without other symptoms<\/li>\n\n\n\n<li>Initial response to topical \/ oral treatment<\/li>\n\n\n\n<li>short lived, frequent relapses<\/li>\n<\/ul>\n\n\n\n<p>Complications:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hearing loss (conductive or sensorineural)<\/li>\n\n\n\n<li>Spread of infection (mastoiditis, meningitis, cerebral abscess)<\/li>\n\n\n\n<li>Facial nerve Palsy<\/li>\n<\/ul>\n\n\n\n<p style=\"text-decoration:underline\"><strong>Examination &#8211; otoscopy:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Copious smelly discharge, often little else to see<\/li>\n\n\n\n<li>Might see crusty discharge in attic or squamous debris in canal<\/li>\n\n\n\n<li>Or unusual appearance \u2013 may not have seen before<\/li>\n\n\n\n<li>CHECK for potential complications (see above).<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p>Please refer where topical and oral antibiotics have been tried and thee<\/p>\n\n\n\n<p>Please refer where there is no improvement, or recurrence, despite appropriate management (topical AND oral antibiotics).<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer to ENT<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-5c48b6347c07aaab03e297c31183aa5b\">REFER URGENTLY (OR SAME DAY) WHERE THERE ARE COMPLICATIONS.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Initial management is with topical and oral antibiotics. <\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Chronic Suppurative Otitis Media (CSOM) can be: Cholesteatoma. This is particularly rare (about 9 per 100,000) and presents as: Complications: Examination &ndash; otoscopy:<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3889,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1222],"class_list":["post-22780","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-chronic-suppurative-otitis-media-cholesteatoma"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entpaediatric\/earinfectionschildren\/https-apps-nhslothian-scot-refhelp-chronic-suppurative-otitis-media-cholesteatoma\/\" rel=\"tag\">Chronic Suppurative Otitis Media\/Cholesteatoma<\/a>","rttpg_excerpt":"Chronic Suppurative Otitis Media (CSOM) can be: Cholesteatoma. This is particularly rare (about 9 per 100,000) and presents as: Complications: Examination &ndash; otoscopy:","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22780","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=22780"}],"version-history":[{"count":1,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22780\/revisions"}],"predecessor-version":[{"id":22781,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22780\/revisions\/22781"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3889"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=22780"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=22780"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}