Chronic suppurative otitis media (CSOM) is the inflammation of middle ear and mastoid cavity. It is caused by consistent discharge from the ear (otorrhoea) through a perforated tympanic membrane, leading to hearing loss (partial or complete). 

It is essential to identify the clinical features and risk factors of this condition to be able to treat it as early as possible and achieve better results and fewer complications in the long term.

For medical students, particularly the aspirants of the NEET PG exam, understanding CSOM helps you score high in the exam with practical clinical judgment. Read on to have a better understanding of this condition.

What is CSOM?

Chronic suppurative otitis media (CSOM) is a perforation of the tympanic membrane that is chronic with persistent middle ear discharge. The condition usually persists for more than six weeks and may present either with or without cholesteatoma, a destructive accumulation of skin cells within the middle ear.

CSOM can be broadly categorised into 2 types: benign and malignant. The benign type, or CSOM without cholesteatoma, typically includes central eardrum perforation and has a lesser chance of severe complications. 

However, the malignant type, or CSOM with cholesteatoma, tends to involve the bony walls of the external ear canal and is marked by destructive growth of the middle ear skin cells that can have fatal repercussions.

CSOM is also classified according to the nature of discharge. Active CSOM is characterised by persistent drainage of a thick, foul-smelling, and purulent fluid from a perforated tympanic membrane. Inactive CSOM has a dry middle ear with no discharge.

What Causes CSOM?

Although the majority of acute otitis media in children is due to viral infections, bacterial infections are most frequently implicated in chronic suppurative otitis media. Staphylococcus aureus, Pseudomonas aeruginosa, Proteus, Klebsiella, Bacteroides, and Fusobacterium are common pathogens in these cases. 

Fungi, like Aspergillus and Candida, may also be the aetiology in the immunocompromised. In regions where tuberculosis is endemic, CSOM could be secondary to tubercular infection. Pathogens invade the middle ear cavity through eardrum perforation or ventilation tubes in some patients. 

After entering, these pathogens cause a persistent inflammatory process for longer than six weeks and subsequently result in chronic infection.

What are the Symptoms of CSOM?

Presentation of chronic suppurative otitis media varies depending on the duration and severity of the infection. CSOM symptoms most commonly noticed are:

1. Ear Discharge (Otorrhea): Prolonged or recurrent discharge from the ear. It is thick, malodorous, yellowish or greenish in colour. Drainage can be constant or intermittent.
2. Hearing Loss: Progressive or, in some cases, acute loss of hearing in the affected ear. The hearing loss is also variable and tends to worsen in the case of active illness.
3. Ear Pain or Discomfort: Mild to moderate discomfort in the affected ear that is usually exacerbated during periods of active discharge or infection.
4. Itching or Irritation: Some patients have chronic itching or irritation of the ear canal from inflammation and established discharge.
5. Tinnitus: Ringing, buzzing, or abnormal noises in the ear, which may be noted in certain cases.
6. Sense of Fullness: A feeling of stoppage or pressure in the ear as a result of drainage or persistent inflammation.
7. Fever: Fever may also be present in patients with active or severe infection.

What are the Risk Factors of CSOM?

A number of lifestyle, genetic, and environmental risk factors are involved in the pathogenesis of chronic suppurative otitis media (CSOM). Identification of such risks is helpful in prevention and early management. They are as follows:

• Recurrent episodes of acute otitis media (AOM).
• Living in crowded places.
• Belonging to a large family unit.
• Regular daycare attendance.

Breastfeeding, passive smoking, rate of upper respiratory tract infection (URT), and socio-economic status provide only inconclusive results.

What is the Diagnosis of CSOM?

As CSOM is being diagnosed, the doctor will ask for symptoms, such as how long the patient has had ear discharge, frequent infections, or whether ventilation tubes were ever inserted. If the patient has a chronic history, even when adequately treated, one will consider a suspicion of CSOM.

• Physical Examination

The external ear and postaural area will be visually examined by the doctor. Otoscopic examination can be performed with an otoscope to look at the ear canal and tympanic membrane for structural change or abnormality.

• Diagnostic Tests

To establish a definitive diagnosis, several investigations may be recommended:

• Ear Discharge Analysis: A sample of fluid from the ear canal is sent to the laboratory to identify causative pathogens.
• Audiometry: Helps assess the type and severity of hearing impairment. While most cases show conductive hearing loss, mixed or sensorineural patterns may also be detected.
• CT (computed tomography) Scan or MRI (magnetic resonance imaging): In resistant cases, the imaging studies can identify complications or changes in structure within the ear.

What is the Treatment for CSOM?

CSOM treatment can include:

• Antibiotics: These medications are used to cure bacterial infections.
• Ear Cleaning: Removes pus and dirt from the ear.
• Ear Drops: Medicine applied directly to the infected area.
• Hygiene: Keep the ear clean and dry.
• Surgery: Operations like tympanoplasty or mastoidectomy if medicines do not work.
• Hearing Aids: These are helpful when hearing loss is severe.
• Lifestyle Changes: Protect against triggers of allergies, such as smoking.

FAQs About CSOM

1. What is the CSOM full form in medical terms?

The full form of CSOM is chronic suppurative otitis media.

2. Can CSOM lead to hearing loss?

Yes. CSOM is one of the most common causes of hearing impairment and disability, particularly in impoverished settings. It can also, in severe cases, result in life-threatening intracranial infection or acute mastoiditis.

3. Is CSOM painful?

Mild CSOM will sometimes not be accompanied by pain, but severe cases can result in fever and earache. The pain can be localised behind the ear or within the ear. Some patients also complain of vertigo, experiencing dizziness or a spinning sensation.

4. What are the risk factors for CSOM?

Risk factors are suboptimal antibiotic treatment, frequent upper respiratory infections, nasal mucosal disease, poor overall hygienic status, crowding, and restricted access to health care.

5. Can ear drops be used in CSOM?

Yes. Topical antibiotics are extensively used in the form of ear drops, ointments, sprays, or creams. They are used locally to destroy or inhibit the development of microorganisms that cause infection.

Conclusion

In the event of any CSOM complications in the ears, it is always best to consult a qualified ENT (ear, nose, throat) specialist. Medical students who are preparing for the NEET PG exam, topics like CSOM are of key importance. 

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