Current concepts in the

pathogenesis and treatment of

chronic suppurative otitis media

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INTRODUCTION
Otitis media (OM) refers to a group
of complex infectious and
inflammatory diseases affecting the
middle ear.

AOM may progress to chronic .

suppurative OM (CSOM)
characterized by persistent drainage
from the middle ear associated with
a perforated ear drum
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INSIDENCE AND
EPIDEMIOLOGY
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Greenland
• 0 – 4 yr 14 %
• 3-8 yr 19 -20%
MIKROBIOLOGY
P. aeruginosa S. aureus

India, Nepal, Singapur, Pakistan

HEARING LOSS
• (CHL)
• (SNHL).
THERAPY
Aural Toilet
Topical antibiotics
Keeping draining ear
Otic insufflation powder
clean and dry
(chloramphenicol,
sulfamethoxazol, and
2-3x/ weeks
amphotericin B)
OTOTOPICAL ANTIBIOTICS

Antibiotic drops +
Therapy CSOM
aural toilet

Quinolones
+
Corticosteroids

When ???
-Inflammation of the external auditory
canal or middle ear mucosa
-Granulation tissue is present
SYSTEMIC ANTIBIOTICS
Primary treatment (3 weeks)

Failure

Oral antibiotic: P. aeruginosa &

• Amoxiclav MRSA:
• Erythromycin • Quinolones
• TMP-SMX
• Sulfafurazole
 SURGERY
Tympanomastoidectomy:
• Chronic Cholesteatomatous OM

Mastoidectomy:
• Abscess formation in the mastoid

Tympanoplasty:
• 6 to 12 months after resolution of the
infection.
Recurrent Disease

Etiology :
• oral antibiotics
• nonantibiotic drops
• non-compliance with the treatment regimen
• P. aeruginosa or MRSA
• cholesteatoma
CONCLUSIONS
• CSOM  common chronic infectious disease worldwide.
• Topical antibiotics, (limited to non ototoxic).
• Surgery  risks of worsening hearing

Bacteriophages
 Safe
 Economical
Resistant bacteria
 Self-replicating
 Effective
bactericidal
Thank You