chronic tubotympanic suppurative otitis media

Chronic Tubotympanic Suppurative Otitis Media (CSOM) Description

Chronic tubotympanic suppurative otitis media, also known as CSOM, is a type of ear infection that affects the middle ear and mastoid cavity. It is characterized by:

• Persistent perforation: A long-standing hole in the eardrum (tympanic membrane)
• Suppurative drainage: Chronic discharge or otorrhea through the perforated eardrum
• Middle ear inflammation: Chronic inflammation of the middle ear space, which can lead to hearing loss and other complications

CSOM is a common childhood infectious disease worldwide and is a leading cause of hearing impairment in resource-limited settings. It is less frequently seen in resource-abundant settings.

Key Features:

• Recurrent or persistent ear discharge (otorrhea) through a perforation in the tympanic membrane
• Chronic inflammation of the middle ear space, which can lead to hearing loss and other complications
• Middle ear structures are often damaged; less commonly, intratemporal or intracranial structures are affected

Causes:

CSOM is caused by episodes of upper respiratory infections, which can lead to chronic inflammation and infection of the middle ear space.

Treatment:

Initially, CSOM is treated with topical antibiotics. If patients have severe exacerbations, they may require systemic antibiotics.

References:

• [1] Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear cleft, which presents with recurrent ear discharges or otorrhea through a tympanic membrane perforation. ... A comprehensive description of its clinical feature is fully done. ... their presence was historically denoted by the term “tubotympanic disease” [15]
• [2]

Symptoms of Chronic Tubotympanic Suppurative Otitis Media

Chronic tubotympanic suppurative otitis media is a type of ear infection that affects the middle ear cavity. The symptoms of this condition can vary, but here are some common signs and symptoms:

• Persistent or intermittent aural discharge: This is one of the most distinctive symptoms of chronic tubotympanic suppurative otitis media. The discharge can be mucopurulent or mucoid, usually odorless, and profuse in amount [12].
• Deafness (usually mild): Some people with this condition may experience mild hearing loss due to the infection affecting the middle ear cavity [15].
• Tinnitus: This is a ringing or buzzing sensation in the ears that can be caused by the chronic infection [15].

Other Possible Symptoms

In addition to these symptoms, some people with chronic tubotympanic suppurative otitis media may also experience:

• Ear pain, especially when lying down
• Tugging or pulling at an ear
• Trouble sleeping
• Crying more than usual
• Fussiness
• Trouble hearing or responding to sounds [5]

It's essential to note that these symptoms can vary in severity and duration. If you suspect you or your child has chronic tubotympanic suppurative otitis media, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References:

[5] - Symptoms of chronic otitis media [12] - Chronic Suppurative Otitis Media| causes, symptoms, diagnosis and treatment ... [15] - Chronic Suppurative Otitis Media| causes, symptoms, diagnosis and treatment ...

Diagnostic Tests for Chronic Suppurative Otitis Media (CSOM)

Chronic suppurative otitis media (CSOM) is a perforated tympanic membrane with persistent drainage from the middle ear. Diagnosing CSOM typically involves a combination of clinical evaluation, medical history, and diagnostic tests.

• Clinical Evaluation: A thorough physical examination by an ear, nose, and throat (ENT) specialist or an audiologist is essential to confirm the diagnosis of CSOM. The examination may include otoscopy to visualize the tympanic membrane and middle ear.
• Medical History: A detailed medical history is crucial to understand the patient's symptoms, duration of illness, and any previous treatments.
• Diagnostic Tests:
  • Otoscopic Examination: A visual inspection of the tympanic membrane using an otoscope can confirm the presence of a perforation and drainage from the middle ear.
  • Tympanometry: This test measures the movement of the eardrum and the reflexes of the middle ear muscles. It helps to assess the function of the middle ear system.
  • Acoustic Reflex Testing: This test evaluates the response of the stapes bone in the middle ear to sound stimuli.
  • Pure Tone Audiometry (PTA): PTA measures hearing thresholds in different frequencies and is essential for assessing hearing loss associated with CSOM.
  • Imaging Studies:
    • Computed Tomography (CT) Scan: A high-resolution CT scan may be performed to evaluate the extent of disease, particularly if complications such as cholesteatoma or intracranial abscess are suspected [5].
    • Magnetic Resonance Imaging (MRI): MRI is better suited for evaluating soft tissue involvement and can reveal dural inflammation, sigmoid sinus thrombosis, or other intracranial complications [7].

When to Consider Additional Tests: If there is suspicion of complications such as cholesteatoma, labyrinthitis, or intracranial abscess, additional imaging studies like CT or MRI may be necessary.

References: [1] - Not provided [2] - Not provided [3] - Not provided [4] - Not provided [5] - A high-resolution temporal bone CT scan may provide additional valuable information in patients with CSOM that is unresponsive to medical treatment. [5] [6] - CT scans are used to diagnose complications in chronic suppurative otitis media among 40 patients between June 2018 and June 2019. [5] [7] - MRI is better suited for evaluating soft tissue involvement and can reveal dural inflammation, sigmoid sinus thrombosis, or other intracranial complications [7].

Treatment Options for Chronic Tubotympanic Suppurative Otitis Media

Chronic tubotympanic suppurative otitis media (CSOM) is a type of ear infection that requires proper treatment to prevent complications and promote healing. The following are the common drug treatments used to manage CSOM:

• Topical Antibiotics: Topical antibiotics, such as antibiotic ear drops, are often prescribed to treat CSOM. These medications help to eliminate bacteria from the ear canal and reduce inflammation [5]. Examples of topical antibiotics used to treat CSOM include ciprofloxacin and ofloxacin.
• Systemic Antibiotics: In cases where systemic infection is present, oral or parenteral antibiotics may be necessary to treat the infection [2].
• Topical Corticosteroids: Topical corticosteroids, such as dexamethasone and prednisolone, can help to reduce inflammation and swelling in the ear canal [6].
• Quinolones: Quinolones, a type of antibiotic, have been shown to be effective in treating CSOM compared to no treatment or topical antiseptics only [9].

Treatment Goals

The primary goal of drug treatment for CSOM is to eliminate the infection and prevent complications. Treatment typically involves:

• Complete cleaning of the ear canal
• Careful removal of granulation tissue
• Application of topical corticosteroids and antibiotics

In severe cases, systemic antibiotics and surgery may be necessary [15].

References

[2] The panel concluded that topical antibiotics alone constitute first-line treatment for most patients, barring systemic infection.

[5] When chronic suppurative otitis media flares up, doctors prescribe antibiotic ear drops.

[6] Treatment requires complete cleaning of the ear canal, careful removal of granulation tissue, and application of topical corticosteroids and antibiotics.

[9] Topical quinolones are effective compared to no drug treatment or topical antiseptics only; however, evidence for their superiority over other topical treatments is limited.

[15] Treatment requires complete cleaning of the ear canal, careful removal of granulation tissue, and application of topical corticosteroids and antibiotics. Systemic antibiotics and surgery are reserved for severe cases.

Chronic tubotympanic suppurative otitis media (CSOM) can be challenging to diagnose, and a thorough differential diagnosis is essential to rule out other conditions that may present similarly. Here are some possible differential diagnoses for CSOM:

• Myringitis: This condition involves inflammation of the eardrum, which can cause symptoms similar to those of CSOM, such as ear pain and discharge.
• Otitis externa: Also known as swimmer's ear, this is an infection of the outer ear canal that can cause symptoms like itching, redness, and discharge. However, it typically does not involve a perforated eardrum.
• Mastoiditis: This is an inflammation of the mastoid bone, which can be caused by an infection spreading from the middle ear. Symptoms may include fever, ear pain, and swelling behind the ear.
• Cholesteatoma: Although CSOM can sometimes lead to cholesteatoma (a skin cyst in the middle ear), it is a distinct condition that requires separate diagnosis.

According to search result [11], differential diagnoses for chronic suppurative otitis media include:

• Myringitis
• Otitis externa
• Mastoiditis
• Cholesteatoma

It's essential to note that the affected ear may be the only hearing ear, and poor general condition, advanced age, or excessive general anesthesia risk are factors to consider when deciding whether to proceed with surgery for tubotympanic disease (search result [11]).

In addition, chronic suppurative otitis media is often multi-bacterial with P. aeruginosa and S. aureus being the most common pathogens, respectively (Bareeqa & Ahmed, 2018). This information can be useful in guiding treatment decisions.

References: [1], [4], [11]