Chronic Suppurative Otitis Media (CSOM): History-taking, Diagnosis, and Management

Introduction

Chronic Suppurative Otitis Media (CSOM) is a persistent infection of the middle ear that leads to chronic ear discharge and potential complications. Understanding its history-taking, clinical presentation, diagnostic approach, and management strategies is crucial for effective treatment.

Patient History-taking

Key Questions

• Duration and frequency of ear discharge
• History of acute otitis media or previous ear infections
• Exposure to water or trauma
• Associated symptoms like hearing loss, otalgia, or vertigo

Risk Factors

• Recurrent upper respiratory infections
• Allergies and eustachian tube dysfunction
• Poor socioeconomic conditions affecting hygiene
• Previous ear surgery or perforation

Clinical Presentation

Patients commonly present with persistent, painless otorrhea. Associated conductive hearing loss may be noticed due to tympanic membrane perforation.

Diagnostic Evaluation

Clinical Examination

Otoscopy reveals perforation in the tympanic membrane, typically central or attic type. The presence of granulation tissue or cholesteatoma may indicate complications.

Investigations

• Audiometry for hearing assessment
• Cultures of ear discharge to identify pathogens
• Imaging such as CT scans if cholesteatoma is suspected

Management Strategies

Medical Management

• Topical and systemic antibiotics based on culture results
• Aural toilet and cleaning
• Anti-inflammatory and antiseptic ear drops

Surgical Management

• Tympanoplasty to repair the tympanic membrane
• Mastoidectomy if chronic infection extends to the mastoid

Conclusion

CSOM requires early diagnosis and appropriate intervention to prevent hearing loss and complications. Patients should be educated on ear hygiene and the importance of follow-up care.