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Chronic tubotympanic suppurative otitis media — Clinical Guidelines

Overview

Chronic tubotympanic suppurative otitis media (CSOM) is a persistent middle ear infection characterized by recurrent discharge through a perforated tympanic membrane, often leading to complications such as hearing loss, tympanosclerosis, and cholesteatoma 24 32.

Diagnosis

Key Criteria: Persistent otorrhea for at least two weeks, presence of a tympanic membrane perforation, and evidence of middle ear disease on otoscopy 32.

Recommended Tests: Tympanometry to assess middle ear function, audiometry for hearing assessment, and tympanocentesis if necessary to obtain cultures 24.

Grading: Classification systems like the WHO classification can help stratify severity based on clinical findings and complications 32.

Management

First-Line Treatments: Topical antibiotic drops (e.g., ciprofloxacin, aminoglycosides) applied to the ear canal 24.

Adjunctive Treatments: Systemic antibiotics for severe cases or when there is evidence of systemic infection 24.

Surgical Intervention: Tympanoplasty for recurrent cases or when there is significant hearing loss or complications like cholesteatoma 14 32.

Special Populations

Pediatrics: Early surgical intervention (myringoplasty or type I tympanoplasty) may be preferred over prolonged medical management to prevent developmental hearing loss 32.

Elderly: Consider comorbidities and functional status; surgical options should be carefully evaluated for risks and benefits 24.

Key Recommendations

Initiate topical antibiotic therapy for persistent otorrhea in CSOM (Evidence: Strong 24).

Consider surgical repair (tympanoplasty) in cases with recurrent infections, significant hearing loss, or complications like cholesteatoma (Evidence: Moderate 14 32).

Regular audiometric monitoring is essential to assess hearing outcomes and guide management decisions (Evidence: Moderate 24).

References

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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2020. link 10 Moskowitz HS, Hsueh WD. Integrative resident education curriculum to adapt to the modern otolaryngology trainee. The Laryngoscope 2020. link 11 Sato E, Mitani S, Nishio N, Kitani T, Sanada T, Ugumori T et al.. Development of proficiency-based knot-tying and suturing curriculum for otolaryngology residents: A pilot study. Auris, nasus, larynx 2020. link 12 Dhillon VK, Dailey SH, Akst LM. Microlaryngeal Teaching Courses: A National Survey on Prevalence, Value, and Barriers to Implementation. The Annals of otology, rhinology, and laryngology 2020. link 13 Villwock JA, Bowe SN, Rotich DC, Beltramo A, Friedman A, Kraft SM. What makes us tick: Implications of personality differences among otolaryngology residents and faculty. The Laryngoscope 2019. link 14 Smith AKK, Sokdavy T, Sothea C, Pastrana MKR, Ali RF, Huins CT et al.. Implementation and results of a surgical training programme for chronic suppurative otitis media in Cambodia. The Journal of laryngology and otology 2018. link 15 Wong K, Jang M, Gilad A, Levi JR. Resident Involvement in Professional Otolaryngology Organizations: Current Trends in the United States. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2017. link 16 Jafari A, Tringale KR, Campbell BH, Husseman JW, Cordes SR. Impact of Humanitarian Experiences on Otolaryngology Trainees: A Follow-up Study of Travel Grant Recipients. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2017. link 17 Awad Z, Hayden L, Robson AK, Muthuswamy K, Tolley NS. Reliability and validity of procedure-based assessments in otolaryngology training. The Laryngoscope 2015. link 18 McMains KC, Peel J, Weitzel EK, Der-Torossian H, Couch M. Perception of Shame in Otolaryngology-Head and Neck Surgery Training. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2015. link 19 Awad Z, Hayden L, Muthuswamy K, Ziprin P, Darzi A, Tolley NS. Does direct observation of procedural skills reflect trainee's progress in otolaryngology?. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2014. link 20 Lin SY, Laeeq K, Malik A, Diaz Voss Varela DA, Rhee JS, Pillsbury HC et al.. Otolaryngology training programs: resident and faculty perception of the mentorship experience. The Laryngoscope 2013. link 21 Crespo AN. Evaluation and classification of residence programs in Otorhinolaryngology. Brazilian journal of otorhinolaryngology 2013. link 22 Hughes JP, Quraishi MS. YouTube resources for the otolaryngology trainee. The Journal of laryngology and otology 2012. link 23 Puscas L. Otolaryngology resident in-service examination scores predict passage of the written board examination. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2012. link 24 Gurgel RK, Miller RA, Smith RJ. Use of portfolios in otolaryngology graduate medical education. The Laryngoscope 2011. link 25 Riess H, Kelley JM, Bailey R, Konowitz PM, Gray ST. Improving empathy and relational skills in otolaryngology residents: a pilot study. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2011. link 26 Varela DA, Malik MU, Laeeq K, Pandian V, Brown DJ, Weatherly RA et al.. Learning styles in otolaryngology fellowships. The Laryngoscope 2011. link 27 Singer MC. The future of otolaryngology training threatened: the negative impact of residency training reforms. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2010. link 28 Gurgel RK, Schiff BA, Flint JH, Miller RA, Zahtz GD, Smith RV et al.. Mentoring in otolaryngology training programs. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2010. link 29 Fennessy BG, O'Sullivan P. Establishing a temporal bone laboratory: considerations for ENT specialist training. Irish journal of medical science 2009. link 30 Wasson J, Jacobsen N, Bowdler D, Hopkins C. Optimizing training opportunities for otolaryngology senior house officers: an audit. The Journal of laryngology and otology 2006. link 31 Kupferman TA, Lian TS. Implementation of duty hour standards in otolaryngology-head and neck surgery residency training. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2005. link 32 Lancaster JL, Makura ZG, Porter G, McCormick M. Paediatric tympanoplasty. The Journal of laryngology and otology 1999. link 33 Watson C. Senior registrar training in otolaryngology: an audit of trainees. Clinical otolaryngology and allied sciences 1991. link

Chronic tubotympanic suppurative otitis media