Clinical Review Extracts from “Concise Clinical Evidence”

Clinical reviewChronic suppurative otitis mediaCommentary: Interpreting the evidence

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7373.1159 (Published 16 November 2002) Cite this as: BMJ 2002;325:1159

Chronic suppurative otitis media

  1. Jose Acuin, consultant
  1. De La Salle University, Cavite, Philippines
  2. University of Glasgow, Glasgow G14 3PQ

    Definition Chronic suppurative otitis media is a persistent inflammation of the middle ear or mastoid cavity. Synonyms include chronic otitis media (without effusion),” chronic mastoiditis, and chronic tympanomastoiditis. Chronic suppurative otitis media is characterised by recurrent or persistent ear discharge (otorrhoea) over 2-6 weeks through a perforation of the tympanic membrane. Typical findings also include thickened granular middle ear mucosa, mucosal polyps, and cholesteatoma within the middle ear. Chronic suppurative otitis media is differentiated from chronic otitis media with effusion, in which there is an intact tympanic membrane with fluid in the middle ear but no active infection. Chronic suppurative otitis media does not include chronic perforations of the eardrum, which are dry, or discharge only occasionally, and have no signs of active infection.

    What are the effects of treatments in adults?

    Likely to be beneficial

    Topical antibiotics

    Randomised controlled trials (RCTs) found limited evidence that topical quinolone antibiotics versus placebo improved otoscopic appearances. RCTs found no clear evidence of significant differences between topical antibiotics. Case studies have associated topical non-quinolone antibiotics with ototoxicity, affecting mainly vestibular function, although RCTs have found few adverse events associated …

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