Chronic Otitis Media

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Introduction

• A chronic inflammatory condition of the middle ear mucosa associated with recurrent ear discharge, often over a period of years

EpidemiologyOccurs in two clinical varieties, with mixed bacteriology, usually gram- negative organisms (Proteus, Pseudomonas)

• The more common simple type with a central eardrum perforation
• The much less common, serious type often associated with the presence of cholesteatoma

Clinical features

• Main complaints: recurrent ear discharge (mucoid in simple type; thick and foul-smelling in serious type) and increasing deafness
• Pain is uncommon
• Central eardrum perforation is of varying size may occur
• Cholesteatoma and marginal or attic perforation is seen in the serious type

Complications

• Intracranial suppuration (extradural abscess, meningitis, or brain abscess
• Lateral sinus thrombosis
• Facial nerve paralysis
• Labyrinthitis

Investigations

• Ear swab for MCS
• Audiogram: conductive deafness
• X-ray of the mastoids: shows sclerosis
• Hypopneumatization
• CT Scan of Petromastoid: Axial, coronal views
• MRI of the petromastoid

Treatment goals

• To give the patient a safe and dry ear
• To preserve or restore hearing as much as possible

Non-drug treatment

• Careful ear toileting and regular ear dressing with an antiseptic pack
• Myringoplasty to protect the middle ear and improve hearing in dry ears with persistent perforation
• Mastoid operation when there is cholesteatoma unresponsive to Treatment

Drug treatment

• Antibiotic - Co-amoxiclav
• Adult: 500/125 mg orally every 8 hours for acute exacerbations up to 14 days
• Child:
  • 6 - 12 years: 250 mg orally 12 hourly;
  • under 6 years: 125 mg 12 hourly

Refer to specialist if no improvement with following antibiotic treatment

Supportive measures

• Protect ears from water with Vaseline/cotton wool while bathing

Caution

• Do not use topical ototoxic antibiotics in the presence of perforation