Chronic suppurative otitis media


Chronic suppurative otitis media (CSOM) is persistent inflammation of the middle ear or mastoid cavity. Synonyms include "chronic otitis media", chronic mastoiditis, and chronic tympanomastoiditis. CSOM is characterised by recurrent or persistent ear discharge (otorrhoea) over 2 to 6 weeks through a perforation of the tympanic membrane. CSOM usually begins as a complication of persistent acute otitis media (AOM) with perforation in childhood. Typical findings may also include thickened granular middle-ear mucosa and mucosal polyps. Occasionally, CSOM will be associated with a cholesteatoma within the middle ear. CSOM is differentiated from chronic otitis media with effusion, in which there is an intact tympanic membrane with fluid in the middle ear but no active infection. CSOM does not include chronic perforations of the eardrum that are dry, or only occasionally discharge, and have no signs of active infection. Cholesteatoma is an abnormal accumulation of squamous epithelium usually found in the middle ear cavity and mastoid process of the temporal bone. Granulation tissue and ear discharge are often associated with secondary infection of the desquamating epithelium. Cholesteatoma is most often detected by careful otoscopic examination in children or adults with persistent discharge that does not respond to treatment.