Chronic suppurative otitis media
Chronic suppurative otitis media is an infection of the middle ear with a perforated eardrum and discharge for at least 6 weeks. Chronic suppurative otitis media can cause hearing impairment and disability. Occasionally, especially in developing countries and Aboriginal or Torres Strait Islander people1, serious complications can occur, such as intracranial infection and mastoiditis.
For patients with chronic suppurative otitis media (whether or not a tympanostomy tube has been inserted), dry aural toilet may be performed. The aim is to clean the external ear canal, but it may be uncomfortable and does not have strong evidence to support its use. A healthcare professional may use mechanical suction or (under direct visualisation) cotton wool on a probe. The patient or carer may use a rolled tissue spear or similar to dry mop the ear 6-hourly until the external ear canal is dryBhutta, 2020.
Aminoglycoside-containing ear drops have previously been used for chronic suppurative otitis media; however, because of safety concerns, in particular the risk of auditory and vestibular toxicity, quinolone ear drops are preferred.
To treat chronic suppurative otitis media, useChong, Head, Webster, Daw, , 2021Head, 2020Head, 2020:
ciprofloxacin 0.3% ear drops, 5 drops into the affected ear, 12-hourly until the middle ear has been free of discharge for at least 3 days. ciprofloxacin
There is inadequate evidence to support the use of combination corticosteroid and antimicrobial ear drops for the treatment of chronic suppurative otitis mediaBrennan-Jones, Chong, , 2020Brennan-Jones, Head, , 2020.
Do not use oral antibiotic therapy for chronic suppurative otitis mediaChong, Head, Webster, Dew, , 2021Onali, 2018.
Persistent discharge may require prolonged courses of treatment. Consider audiology and speech pathology referral. Referral to an otolaryngologist is recommended for further examination and to exclude cholesteatoma or chronic osteitis.