Chronic otitis media is a condition that encompasses a group of chronic inflammatory conditions of the middle ear, including chronic suppurative otitis media (CSOM) and chronic otitis media with effusion (COME).

CSOM presents with ongoing purulent or mucoid drainage from the middle ear; it is associated with tympanic membrane (TM) perforation and often involves some degree of hearing loss. A cholesteatoma or polyp may be present. It may be unilateral or bilateral. It occurs more often in children but can occur in adults. Other signs and symptoms include otalgia, purulent malodorous discharge, and pruritus. Untreated infection may lead to complications, including irreversible hearing loss, petrositis, meningitis, labyrinthitis, lateral sinus thrombophlebitis, and facial paralysis.

COME, often called glue ear, results from chronic eustachian tube dysfunction. Patients present with complaints of pressure and hearing loss for several weeks or more on the affected side. This is best assessed by pneumatic otoscopy and direct visualization of the TM. Otoscopic findings include an opaque TM with effusion with or without TM retraction or air-fluid levels.

Management of CSOM includes relief of symptoms and prevention of progression to severe and damaging complications. Measures include tympanostomy tube placement and regular aural toilet and quinolone antibiotic ear drops during times of otorrhea. Tympanoplasty without mastoidectomy for noncholesteatomatous chronic otitis media may be called for. Other types of surgery depend on the extent of complications and include removal of infected ear tissue, repair of damaged ear structures, mastoidectomy, ossicular reconstruction, and tympanoplasty.

Pseudomonas, Staphylococcus, Proteus, and Klebsiella are the most common organisms recovered in cultures from patient with CSOM. Repeat cultures can guide antibiotic choices in refractory cases.

Management of COME often includes a formal hearing evaluation to detect hearing loss, tympanostomy tube placement, adenoidectomy, and speech therapy to remediate any speech delays. This is most often seen in the pediatric patient population.

Related topic: acute otitis media