10 things you should know about chronic suppurative otitis media

What Is the Middle Ear
The middle ear is an air-filled cavity that is present behind the eardrum. It consists of three tiny bones, known as the ear ossicles, that aid in the transmission of sound vibrations. It also consists of a structure called the eustachian tube, which helps in connecting the middle ear to the back of the nose and throat.(Image: Canva)

Definition of CSOM
Chronic suppurative otitis media refers to a long-standing infection of a part or the whole of the middle ear, characterised by ear discharge and also a perforation of the ear drum. This perforation may become permanent and can need a surgery known as tympanoplasty.(Image: Canva)

Age and Healthcare Access
Multiple factors can influence the incidence of complications in people who have chronic suppurative otitis media. Age is a vital factor, as complications are more likely in the first decade of life or in older adults, especially when their resistance has become low. Limited healthcare in certain areas can also increase the risk.(Image: Canva)

Living Conditions and Organisms
People living in overly crowded areas and those who do not have access to adequate health education are more susceptible to have complications. Other factors include lack of personal hygiene, and infection by highly virulent organisms like Haemophilus influenza.(Image: Canva)

Role of Medication and Illness
Drugs may also be the cause of complications if given in insufficient doses or period of administration of the prescribed antibiotics. People who have other diseases like HIV-AIDS, diabetes that is not controlled, and people who have been receiving immunosuppressants-suppressive drugs or chemotherapeutic agents.(Image: Canva)

Spread Through Ear Clefts
The infection from the middle ear can traverse through the cleft because of previous ear surgery, fracture of temporal bone or stapedectomy. Inflammation of the mucosal lining of the mastoid air cell system (mastoiditis) can be a sequelae. Poor nutrition is also an important cause for the development of complications.(Image: Canva)

Facial Nerve Paralysis
Ordinarily, the facial nerve is well protected in the bony canal. At times, the bony canal may be damaged, and the nerve comes to lie close to the middle ear mucosa. In such cases, inflammation of the middle ear can spread, thus leading to facial paralysis. It can fully recover if the acute episode of middle ear infection is controlled with antibiotics.(Image: Canva)

Signs of Extradural Abscess
Persistent headache, severe pain in the ear, generalised weakness with a low grade fever and pulsatile pus-filled ear discharge may be seen if the person develops an extradural abscess. This can be diagnosed using a CT scan or an MRI. A surgery known as mastoidectomy may be needed to relieve these symptoms.(Image: Canva)

Meningitis as a Complication
Inflammation of the meninges, called meningitis, is one of the most common intracranial complications of chronic suppurative otitis media. It can present as a rise in temperature along with chills and rigors, headache, neck rigidity, and photophobia. Mental irritability, nausea and vomiting, along with drowsiness which may progress to coma if not treated adequately.(Image: Canva)

Treatment and Aural Toilet
The aim of the treatment in suppurative otitis media is to control the infection and remove the ear discharge. Aural toilet can help in removing the discharge and debris from the ear. It may be done using a suction or by dry mopping. Ear drops and antibiotics may be prescribed, and once the ear is dry, reconstructive surgery is considered.(Image: Canva)