What is the presentation of chronic suppurative otitis media (CSOM)?

Presentation of Chronic Suppurative Otitis Media (CSOM)

Chronic suppurative otitis media (CSOM) is primarily characterized by chronic discharge from the middle ear through a perforation of the tympanic membrane. 1 This persistent ear discharge (otorrhea) is the hallmark clinical presentation, typically lasting for more than two weeks.

Key Clinical Features

Primary Symptoms

• Ear discharge (otorrhea)

  • Persistent discharge through a perforated tympanic membrane 1
  • May be purulent, mucoid, or mucopurulent
  • Often chronic, lasting more than two weeks 2

• Hearing loss

  • Conductive hearing loss of variable severity
  • Average hearing loss of approximately 25 decibels in patients with middle ear fluid 1
  • May significantly impact language development and cognitive abilities, especially in children 3

Physical Examination Findings

• Perforated tympanic membrane (essential diagnostic feature) 1
• Visible middle ear discharge through the perforation
• Middle ear mucosa may appear inflamed or edematous
• Granulation tissue may be present in chronic cases

Associated Complications

Hearing-Related Complications

• Persistent conductive hearing loss 3
• Potential impact on speech and language development in children
• Possible negative effects on educational achievement and cognitive abilities 1

Serious Complications (Less Common)

• Mastoiditis (inflammation of the mastoid air cells)
• Intracranial complications (rare in developed countries) 1
  • Meningitis
  • Brain abscess
  • Focal encephalitis 4

Microbiological Aspects

CSOM is typically polymicrobial in nature (involving more than one microorganism) 2. Common pathogens include:

• Pseudomonas aeruginosa
• Staphylococcus aureus
• Proteus species
• Klebsiella species
• Anaerobic bacteria

Diagnostic Considerations

• Diagnosis is primarily clinical, based on:

  • History of persistent ear discharge
  • Otoscopic confirmation of tympanic membrane perforation
  • Duration of symptoms (>2 weeks)

• Pneumatic otoscopy is recommended as the primary diagnostic method 3

• Tympanometry may be used to objectively measure middle ear function if visualization is difficult 3

• Microbiological diagnosis requires culture of ear discharge

Clinical Course and Prognosis

Without appropriate treatment, CSOM can lead to:

• Persistent hearing impairment
• Recurrent episodes of acute infection
• Potential for serious complications in untreated cases
• Negative impact on quality of life due to chronic discharge and hearing loss

Important Distinctions

CSOM should be distinguished from:

• Acute otitis media (AOM) - characterized by acute signs and symptoms of middle ear inflammation
• Secretory otitis media (SOM) - presence of middle ear effusion without perforation or discharge 1
• Otitis media with effusion (OME) - fluid behind an intact tympanic membrane without signs of acute infection 1

Special Considerations

• In developing countries, CSOM represents a significant cause of preventable hearing loss 1
• Regular audiological monitoring is necessary to ensure appropriate hearing levels for language and educational development 3
• Persistent cases may require referral to specialists, particularly when complications are suspected 3

The chronic nature of the discharge and the presence of a tympanic membrane perforation are the defining characteristics that distinguish CSOM from other forms of otitis media.