Consultation with the specialist: Chronic suppurative otitis media.

Abstract

1. Charles D. Bluestone, MD* 2. Jerome O. Klein, MD† 1. 2. *Eberly Professor of Pediatric Otalaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA. 3. 4. †Professor of Pediatrics, Boston Univerisity School of Medicine, Boston MA. Dr Klein is a consultant to Eli Lily Company; is a consultant to and lecturer for Bristol Myers Squibb and SmithKline Beecham; is a consultan to and has grant support from Abott Laboratories abd Pfizer Pharmaceuticals; and is a consultant to a, lecturer for, and has grant support from Roche Laboratories. Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear cleft (including eustachian tube, middle ear, and mastoid) that is defined by three elements: 1) perforation of the tympanic membrane due to acute infection or tympanotomy tube, 2) discharge from the middle ear (otorrhea), and 3) prolonged duration (;gt;2 wk). The initial therapy of most cases is use of appropriate topical and systemic antibiotics, which can be managed by the pediatrician. Otolaryngologic referral is necessary in four circumstances: 1) if otomicroscopy is required for initial or subsequent examination, 2) if the patient fails to respond to initial therapy, 3) if a cholesteatoma or other mass is present, and 4) if a suppurative complication occurs. CSOM affects diverse racial and cultural groups living not only in temperate climates but in climate extremes ranging from the Arctic Circle to the equator. Among the groups affected most are the Inuits of Alaska (30% to 46%), Australian aborigines (12% to 25%), and certain Native Americans (eg, Apache and Navajo tribes) (4% to 8%). Studies from industrialized nations have reported low rates of CSOM due to acute infection with perforation, but many cases of CSOM are associated with use of tympanotomy tubes. No population-based data are available regarding the incidence of CSOM associated with tympanotomy tubes. Risk factors attributed to high rates of CSOM are similar to factors associated with recurrent acute otitis media (AOM): lack of breastfeeding, overcrowding, poor hygiene, poor nutrition, passive smoking, high rates of nasopharyngeal colonization with potentially pathogenic bacteria, and inadequate and unavailable health care. Data from Thailand and Kenya indicate that public health measures and appropriate medical care are effective in decreasing the rate of CSOM. When hearing is assessed in children who have otitis media with effusion (OME), the median level is 25 dB (equivalent …