Chronic Otitis Media: Signs, Symptoms and Treatment in India

What is Chronic suppurative otitis media?

Chronic suppurative otitis media (CSOM) is a chronic inflammatory disease of the middle ear cleft that includes the tympanic membrane (eardrum), ossicles (middle ear bones responsible for hearing) and the mastoid bone (the aerated bone behind the ear). In simple terms, it can be categorized into two chief types: The mucosal variant involving only eardrum and the squamous variant involving the mastoid bone with or without cholesteatoma.

Signs and symptoms of chronic otitis media:

• Ear discharge, recurrent or persistent for more than 12 weeks. The discharge can be profuse or scanty, foul-smelling or odorless, thick or thin, blood-stained or greenish discolored.
• Hearing loss in the affected ear. It can be mild/moderate or severe/profound.

Such symptoms can extend over months or years in affected ear/s.

Signs and symptoms of impending complications in chronic ear disease:

• Recent onset vertigo or imbalance.
• Severe/progressive earache or headache
• Nausea and vomiting
• Weakness or asymmetry of face on affected side.
• Pain or swelling behind the ear, particularly in children.
• Sudden progression of hearing loss/total deafness.
• Fever with headache and neck stiffness/irritability
• Altered consciousness/drowsiness

The above signs and symptoms warrant urgent referral to the ENT surgeon for further management.

Management of Chronic Ear Disease

The management of chronic ear disease is nearly always surgical except in a very elderly or debilitated population who are poor surgical candidates.

1. Tympanoplasty: Tympanoplasty essentially means repair and reconstruction of the perforated or diseased eardrum with or without reconstruction of middle ear hearing/ossicular mechanism. The procedure involves grafting the perforated eardrum using autologous graft tissue (cartilage/fascia).
2. Repair of diseased ossicles (ear bones) can be done in the same sitting using middle ear implants.
3. Mastoidectomy: Mastoidectomy entails the removal of disease from the mastoid bone by drilling the diseased bony cells of this bone behind the ear. Mastoidectomy can be of two essential types namely:

1. Cortical mastoidectomy: This removes diseased mastoid cells in bone to reduce infective load and is a limited procedure and maintains the normal ear anatomy.
2. Radical or modified radical mastoidectomy: This is an extensive procedure needing removal and exteriorization of the entire middle ear and mastoid system thereby removing extensive disease and converting the entire region into a common cavity approached post-operatively through a widened external ear meatus. The scope, hospital stay and post-operative recovery is different for all these procedures.

FAQs about CSOM

Question 1. How can I get evaluated if I have symptoms?

Answer: Clinical examination by an otologist/ENT surgeon followed by Examination under a microscope, Audiometry and High resolution computed tomography of the temporal bone.

Question 2. How much will my hearing recover after surgery?

Answer: This depends on your pre-operative hearing level. Certain hearing loss can be corrected in the same or second surgery whereas some kinds of hearing loss involving inner ear may not be reversible.

Question 3. How important or urgent is the surgery?

Answer: While surgery for eardrum perforation or hearing reconstruction is elective, surgery for squamous variant or “unsafe ear” must not be deferred as it is a progressive disease and can lead to ear or brain complications in absence of definitive treatment.

Question 4. What kind of follow up would I require after surgery?

Answer: While a normal follow up after tympanoplasty or cortical mastoidectomy could all be 4-8 weeks with native ENT surgeon, we recommend a lifelong follow up for patients needing radical or open cavity mastoidectomy. The large cavity status post-operatively makes such patients prone to occasional discharge and wax or fungal collection that can be managed in outpatient using ear suction cleaning and relevant anti-bacterial or anti-fungal ear drops.

Question 5. What are the various methods of hearing reconstruction if I have already undergone tympanoplasty or mastoidectomy and continue to hear less from one or both ears?

Answer: There are multiple methods of hearing improvement. These range from the use of hearing aids in the elderly or surgical reconstruction of the hearing mechanism using either of these methods:

1. Ossiculoplasty: Reconstruction of middle ear ossicles/bones using titanium implants.
2. Bone anchored hearing implants: For patients with open cavities or radical mastoidectomies on both sides.
3. Active middle ear implants (Vibrant Soundbridge): For patients with mixed hearing loss with both conductive and sensorineural hearing loss component and when patients are not comfortable wearing hearing aids.
4. Cochlear implants: To correct severe to profound hearing loss not amenable to any other non-surgical or surgical modality.