Chronic Otitis Media

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This is a chronic infection of the middle ear with perforation of the tympanic membrane and pus discharging from the ear for more than 2 weeks.

Cause

  • Secondary bacterial infections:
    • Pseudomonas aeruginosa 
    • Proteus vulgaris   
    • Pnuemococci

Symptoms

  • Chronic ear discharge (otorrhoea)
  • Hearing loss 

Signs

  • Perforation of tympanic membrane 
  • Conductive hearing loss
  • Ear discharge 

Investigations

  • Ear swab for culture and sensitivity

TreatmentTreatment Objectives

  • To keep the ear dry
  • To treat any acute exacerbations and complications e.g. mastoiditis

Non-pharmacological treatment

  • Roll a piece of clean absorbent gauze into a wick and insert carefully into the ear. Leave for one minute then remove and replace with a clean wick. Do frequently (at least 4 times a day)
  • If bleeding occurs, drying the ear should be stopped temporarily
  • Nothing should be left in the ear between wicking 
  • Avoid swimming or getting the inside of the ear wet
  • Re-assess weekly to ensure that the mother is drying the ear correctly

Pharmacological treatment 

For acute exacerbations

(See section on Treatment for ‘Acute Otitis Media’)

For topical antibiotic therapy

Evidence Rating: [B]

  • Gentamicin ear drops, 0.3%, 2-3 drops 6-8 hourly and at night

Or

  • Ciprofloxacin eye/ear drops, 0.3%, 1 drop 6 hourly daily

Referral CriteriaRefer all chronically discharging ears to the ENT Specialist