Chronic Suppurative Otitis Media Workup

Updated: Jan 12, 2021
  • Author: Denny Varughese, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Approach Considerations

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.


Imaging Studies

A high-resolution temporal bone CT scan may provide additional valuable information in patients with CSOM that is unresponsive to medical treatment. Temporal bone CT scanning may reveal osseous erosion of the scutum, ossicles, ear canal, mastoid, otic capsule, fallopian canal, or tegmen, which typically suggests cholesteatoma. Additional findings revealed with CT scanning include subperiosteal abscess or intracranial abscess, and, in some cases, lateral sinus thrombosis. Other possible reasons for persistent CSOM include an occult cholesteatoma or a foreign body.

CT scanning is universally recommended if the clinician suspects a neoplasm or anticipates intratemporal or intracranial complications.

MRI scans of the temporal bone and brain should be obtained 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 prior to any otologic surgery, except in cases in which urgent surgery is necessary as a life-preserving measure. Conductive hearing loss is expected, but mixed or sensorineural hearing loss may indicate more extensive disease and should alert the treating physician of impending complications, including labyrinthine fistula or labyrinthitis.

A study by Sheikh et al indicated that preoperative audiograms can predict whether or not ossicular discontinuity has occurred in CSOM, with the presence of large air-bone gaps at both 1000 and 2000 Hz being a reliable sign of such discontinuity. [31]

Another study, by Sarmento, Jr, et al, found high-frequency conductive hearing loss testing can be used to diagnose incomplete ossicular discontinuity with a sensitivity of 83% and a specificity of 92%. [32]