eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Chronic Suppurative Otitis, Medical Treatment: Differential Diagnoses & Workup

Author: David Parry, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, ENT Associates of Children's Hospital, Boston
Coauthor(s): Peter S Roland, MD, Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development
Contributor Information and Disclosures

Updated: Jul 7, 2009

Differential Diagnoses

Wegener Granulomatosis

Other Problems to Be Considered

Langerhans cell histiocytosis
Neoplasia
Foreign body
Cholesteatoma
Sigmoid sinus thrombosis
Brain abscess
Otitic hydrocephalus
Extradural abscess
Meningitis
Tuberculosis
Petrositis
Labyrinthitis

Workup

Laboratory Studies

  • Reasonable chronic suppurative otitis media (CSOM) treatment plans can be developed without lab studies.
  • Prior to instituting systemic therapy, a culture should be obtained for sensitivity. Sensitivity testing is important when systemic therapy is being considered.

Imaging Studies

  • CT scanning
    • If CSOM is unresponsive to medical treatment, a fine-cut CT scan of the temporal bone may provide an explanation. Possible reasons for failed treatment include occult cholesteatoma or foreign body.
    • CT scanning is a necessary adjunct to treatment if the clinician suspects a neoplasm or if the clinician anticipates intratemporal or intracranial complications.
    • A fine-cut CT scan can reveal bone erosion from cholesteatoma, ossicular erosion, involvement of petrous apex, coalescent mastoiditis, erosion of the fallopian canal, and subperiosteal abscess.
  • MRI
    • Use MRI of the temporal bone and brain if intratemporal or intracranial complications are suspected.
    • By clearly depicting soft tissues, MRI can reveal dural inflammation, sigmoid sinus thrombosis, labyrinthitis, and extradural and intracranial abscesses.

Other Tests

An audiogram should be performed. Conductive hearing loss is expected, but mixed hearing loss may indicate more extensive disease and should alert the treating physician of impending complications.

More on Middle Ear, Chronic Suppurative Otitis, Medical Treatment

Overview: Middle Ear, Chronic Suppurative Otitis, Medical Treatment
Differential Diagnoses & Workup: Middle Ear, Chronic Suppurative Otitis, Medical Treatment
Treatment & Medication: Middle Ear, Chronic Suppurative Otitis, Medical Treatment
Follow-up: Middle Ear, Chronic Suppurative Otitis, Medical Treatment
Multimedia: Middle Ear, Chronic Suppurative Otitis, Medical Treatment
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol. May 2008;122(5):442-6. [Medline].

  2. Matsuda Y, Kurita T, Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on middle-ear sound transmission. J Laryngol Otol. May 2009;123 Suppl 31:81-9. [Medline].

  3. Wright D, Safranek S. Treatment of otitis media with perforated tympanic membrane. Am Fam Physician. Apr 15 2009;79(8):650, 654. [Medline].

  4. van der Veen EL, Schilder AG, van Heerbeek N, Verhoeff M, Zielhuis GA, Rovers MM. Predictors of chronic suppurative otitis media in children. Arch Otolaryngol Head Neck Surg. Oct 2006;132(10):1115-8. [Medline].

  5. Smith JA, Danner CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngol Clin North Am. Dec 2006;39(6):1237-55. [Medline].

  6. Agro AS, Garner ET, Wright JW 3rd. Clinical trial of ototopical ofloxacin for treatment of chronic suppurative otitis media. Clin Ther. Jul-Aug 1998;20(4):744-59. [Medline].

  7. Bance M, Rutka JA. Topical treatment for otorrhea: issues and controversies. J Otolaryngol. Aug 2005;34 Suppl 2:S52-5. [Medline].

  8. Brown OE, Meyerhoff WL. Complications and Sequelae of Chronic Suppurative Otitis Media. Ann Otol Rhinol Laryngol. 1988;97(suppl 131):38-40.

  9. Consensus Panel, Hannley MT, Dennenny III JC. Use of Ototopical Antibiotics in Treating 3 Common Ear Diseases. Otol Head Neck Surg. 2000;934-40.

  10. Dohar JE. Old and New Ototopical Agents for the Acute and Chronic Draining Ear. Seminars in Otitis Media Management. 1998;1:1-14.

  11. Dohar JE, Alper CM, Rose EA. Treatment of chronic suppurative otitis media with topical ciprofloxacin. Ann Otol Rhinol Laryngol. Oct 1998;107(10 Pt 1):865-71. [Medline].

  12. Dohar JE, Kenna MA, Wadowsky RM. Therapeutic implications in the treatment of aural Pseudomonas infections based on in vitro susceptibility patterns. Arch Otolaryngol Head Neck Surg. Sep 1995;121(9):1022-5. [Medline].

  13. Esposito S, D'Errico G, Montanaro C. Topical and oral treatment of chronic otitis media with ciprofloxacin. A preliminary study. Arch Otolaryngol Head Neck Surg. May 1990;116(5):557-9. [Medline].

  14. Esposito S, Noviello S, D'Errico G, Montanaro C. Topical ciprofloxacin vs intramuscular gentamicin for chronic otitis media. Arch Otolaryngol Head Neck Surg. Aug 1992;118(8):842-4. [Medline].

  15. Force RW, Hart MC, Plummer SA. Topical ciprofloxacin for otorrhea after tympanostomy tube placement. Arch Otolaryngol Head Neck Surg. Aug 1995;121(8):880-4. [Medline].

  16. Gehanno P. Multicenter study of the efficacy and safety of oral ciprofloxacin in the treatment of chronic suppurative otitis media in adults. The French Study Group. Otolaryngol Head Neck Surg. Jul 1997;117(1):83-90. [Medline].

  17. Hampel B, Hullmann R, Schmidt H. Ciprofloxacin in pediatrics: worldwide clinical experience based on compassionate use--safety report. Pediatr Infect Dis J. Jan 1997;16(1):127-9; discussion 160-2. [Medline].

  18. Hannley MT, Denneny JC 3rd, Holzer SS. Use of ototopical antibiotics in treating 3 common ear diseases. Otolaryngol Head Neck Surg. Jun 2000;122(6):934-40. [Medline].

  19. Ibekwe AO, al Shareef Z, Benayam A. Anaerobes and fungi in chronic suppurative otitis media. Ann Otol Rhinol Laryngol. Aug 1997;106(8):649-52. [Medline].

  20. Indudharan R, Haq JA, Aiyar S. Antibiotics in chronic suppurative otitis media: a bacteriologic study. Ann Otol Rhinol Laryngol. May 1999;108(5):440-5. [Medline].

  21. Kaplan DM, Fliss DM, Kraus M. Audiometric findings in children with chronic suppurative otitis media without cholesteatoma. Int J Pediatr Otorhinolaryngol. Apr 1996;35(2):89-96. [Medline].

  22. Kenna MA. Etiology and Pathogenesis of Chronic Suppurative Otitis Media. Ann Otol Rhinol Laryngol. 1988;97(Suppl 131):16-17.

  23. Kenna MA. Microbiology of Chronic Suppurative Otitis Media. Ann Otol Rhinol Laryngol. 1988;97(suppl 131):9-10.

  24. Kenna MA. Treatment of Chronic Suppurative Otitis Media. Otolaryngol Clinics North Am. 1994;27:457-71.

  25. Kenna MA, Bluestone CD, Reilly JS. Medical management of chronic suppurative otitis media without cholesteatoma in children. Laryngoscope. Feb 1986;96(2):146-51. [Medline].

  26. Kiris M, Berktas M, Egeli E. The efficacy of topical ciprofloxacin in the treatment of chronic suppurative otitis media. Ear Nose Throat J. Nov 1998;77(11):904-5, 909. [Medline].

  27. [Best Evidence] Macfadyen CA, Acuin JM, Gamble C. Topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations. Cochrane Database Syst Rev. 2005;CD004618. [Medline].

  28. Meyerhoff WL. Pathology of Chronic Suppurative Otitis Media. Ann Otol Rhinol Laryngol. 1988;97(suppl 131):21-24.

  29. Meyerhoff WL, Kim CS, Paparella MM. Pathology of chronic otitis media. Ann Otol Rhinol Laryngol. Nov-Dec 1978;87(6 Pt 1):749-60. [Medline].

  30. Noordzij JP, Dodson EE, Ruth RA. Chronic otitis media and sensorineural hearing loss: is there a clinically significant relation?. Am J Otol. Jul 1995;16(4):420-3. [Medline].

  31. Roland PS, Dohar JE, Lanier BJ, et al. Topical ciprofloxacin/dexamethasone otic suspension is superior to ofloxacin otic solution in the treatment of granulation tissue in children with acute otitis media with otorrhea through tympanostomy tubes. Otolaryngol Head Neck Surg. Jun 2004;130(6):736-41. [Medline].

  32. Roland PS, Parry DA, Stroman DW. Microbiology of acute otitis media with tympanostomy tubes. Otolaryngol Head Neck Surg. Oct 2005;133(4):585-95. [Medline].

  33. Sade J, Berco E. Bone destruction in chronic otitis media. A histopathological study. J Laryngol Otol. May 1974;88(5):413-22. [Medline].

  34. Seven H, Coskun BU, Calis AB, et al. Intracranial abscesses associated with chronic suppurative otitis media. Eur Arch Otorhinolaryngol. Oct 2005;262(10):847-51. [Medline].

  35. Smith AW, Hatcher J, Mackenzie IJ. Randomised controlled trial of treatment of chronic suppurative otitis media in Kenyan schoolchildren. Lancet. Oct 26 1996;348(9035):1128-33. [Medline].

  36. Thomsen J, Jorgensen MB, Bretlau P. Bone resorption in chronic otitis media. A histological and ultrastructural study. I. Ossicular necrosis. J Laryngol Otol. Oct 1974;88(10):975-81. [Medline].

  37. Wang PC, Nadol JB Jr, Merchant S. Validation of outcomes survey for adults with chronic suppurative otitis media. Ann Otol Rhinol Laryngol. Mar 2000;109(3):249-54. [Medline].

  38. Wintermeyer SM, Hart MC, Mahata MC. Efficacy of Ototopical Ciprofloxacin ini Pediatric Patients With Otorrhea. Otolaryngol Head Neck Surg. 1997;116:450-53.

  39. Wintermeyer SM, Nahata MC. Chronic suppurative otitis media. Ann Pharmacother. Sep 1994;28(9):1089-99. [Medline].

  40. Wright CG, Meyerhoff WL. Ototopical Agents: Efficacy or Toxicity in Humans. Ann Otol Rhinol Laryngol. 1988;97(suppl 131):30-32.

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines

Evidence based clinical practice guideline for medical management of acute otitis media in children 2 months to 13 years of age.
Cincinnati Children's Hospital Medical Center - Hospital/Medical Center.  1999 (revised 2004 Oct 29; reviewed 2006 Aug).  16 pages.  NGC:003958

Otitis media.
University of Michigan Health System - Academic Institution.  1997 Nov (revised 2007 Jul).  12 pages.  NGC:006032

Adapting your practice: treatment and recommendations for homeless children with otitis media.
Health Care for the Homeless (HCH) Clinician's Network - Medical Specialty Society
National Health Care for the Homeless Council, Inc. - Private Nonprofit Organization.  2003 (revised 2008).  29 pages.  NGC:006943

Clinical trials

Magnetic Resonance (MR) Imaging in the Post Operative Follow-up of Cholesteatoma in Children

Study of Different Kinds of Ear Tubes


Related eMedicine topics

 Otitis Media

Middle Ear, Acute Otitis Media, Surgical Treatment

Middle Ear, Otitis Media With Effusion

Middle Ear, Chronic Suppurative Otitis, Surgical Treatment

Middle Ear, Acute Otitis Media, Medical Treatment

[ CLOSE WINDOW ]

Keywords

chronic otitis media, chronic perforated tympanic membrane, perforated tympanic membrane, chronically draining ear, chronic suppurative otitis media, CSOM, ear infection, chronic otorrhea, cholesteatoma, acute otitis media, AOM, middle ear drainage

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

David Parry, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, ENT Associates of Children's Hospital, Boston
Disclosure: Nothing to disclose.

Coauthor(s)

Peter S Roland, MD, Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development
Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Alcon labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear corp Honoraria Board membership; Med El corp travel grants Consulting

Medical Editor

John C Li, MD, Private Practice in Otology and Neurotology; Medical Director, Balance Center
John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.