Otitis Media, Chronic, Suppurative

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A purulent discharge from the ear with perforation for > 2 weeks. If the eardrum has been ruptured for ≥ 2 weeks, a secondary infection with multiple organisms usually occurs. Oral antibiotic treatment is generally ineffective.

Causes

  • Untreated or unresolved acute otitis media with a central perforation in the ear
  • Recurrent ear discharge usually after Upper respiratory tract infections
  • Secondary infection with gram-negative organisms, yeast and fungi.

Signs and symptoms

  • A purulent discharge from the ear for more than 2 weeks, usually not foul smelling.
  • Impaired hearing.
  • A central perforation in the ear drum.
  • TB may present with a chronically discharging ear. Consider the diagnosis of TB if other Signs and symptoms suggestive of TB are present (e.g. cough, weight loss, excessive night sweats, failure to thrive, etc.). See Section for Pulmonary tuberculosis (TB).

Non-pharmacological treatment

  • Do not send pus swabs collected from the external ear canal for routine bacterial and fungal MC+S (microscopy, culture and sensitivity) or for microscopy and culture for tuberculosis.
  • Explain to patients and caregivers that a chronically draining ear can only heal if it is dry.
  • Dry mopping is the most important part of the treatment. It should be demonstrated to the child’s caregiver or patient if old enough. Roll a piece of clean absorbent cloth into a wick.
    • Carefully insert the wick into the ear with twisting action.
    • Remove the wick and replace with a clean dry wick.
    • Repeat this until the wick is dry when removed.
    • Do not leave anything in the ear.
    • Do not instil anything else in the ear.
    • Avoid getting the inside of the ear wet while swimming and bathing.
    • Check HIV status if unknown

Referral

  • All sick children, vomiting, drowsy, etc. Painful swelling behind the ear.
  • Ear discharge still present for ≥ 4 weeks, despite dry mopping.

Note

  • These referrals do not all require referral to an ENT. They may be referred to a hospital outpatient department for consideration of a topical antibiotic eardrops.
  • Any attic perforation.
  • Any perforation not progressively improving after 3 months or closed by 6 months, even if dry. Moderate or severe hearing loss.