Chronic Otitis Media

Introduction

Chronic otitis media is a chronic inflammatory condition of the middle ear mucosa with recurrent ear discharge often over a period of years.
It occurs in two clinical varieties

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

Bacteriology is usually mixed, mostly gram negative organisms (Proteus, Pseudomonas)

Clinical features

  • Main complaints: recurrent ear discharge and increasing deafness
  • Pain is uncommon
  • Discharge is mucoid in the simple type but thick and foul-smelling in the serious variety.
  • Usually central eardrum perforation is of varying size
  • Cholesteatoma and marginal or attic perforation is seen in the serious type

Complications

Generally more with the serious type:

  • Intracranial suppuration
    • Extradural abscess
    • Meningitis
    • Brain abscess
  • Lateral sinus thrombosis
  • Facial nerve paralysis
  • Labyrinthitis

Investigations

  • Ear swab taken properly for microscopy, culture and sensitivity
  • Audiogram: conductive deafness
  • X-ray of the mastoids: shows sclerosis, hypopneumatization

Treatment objectives

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

Non-drug treatment

  • Careful ear toilet and regular ear dressing with antiseptic pack
  • With dry ear, persistent perforation may be closed surgically (myringoplasty) to protect middle ear and improve hearing
  • In the serious type with cholesteatoma not responding to treatment, mastoid operation is
    done to clear out disease and prevent complications

Drug treatment

Antibiotic

  • Amoxicillin Clavulanic acid

Adult: 500/125 mg orally every 8 hours for acute exacerbations up to 14 days
Child:

  • 6 12 years: 250 mg orally every 12
    hours;
  • under 6 years: 125 mg every 12 hours

If infection does not settle with systemic antibiotics refer to specialist

Supportive measures

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

Caution

  • Topical treatment with ototoxic antibiotics is contraindicated in the presence of a perforation