Chronic suppurative otitis media

He was a young man complaining of reduced hearing in both ears for more than 20 years. Considering the age of the patient, it was apparent that he had the problem since childhood. On questioning, it was revealed that he had the problem of chronic pain and discharge from the ears since early childhood. On examination, it was found that he had chronic suppurative otitis media and it was responsible for the deafness. Otitis is the inflammation or infection of the middle ear. In chronic suppurative otitis media (CSOM), there is perforation of the tympanic membrane and active infection in the middle ear lasting for many days. This is usually associated with pus discharge. The pus if very small in quantity is seen only on examination of the middle ear. If much in quantity, it tends to come out and is felt subjectively by the person. Chronic suppurative otitis is most commonly caused by bacterial infections, though other chronic ear infections occur due to viral and fungal agents. Streptococcus pneumonia is the most common microbe causing it. Infection by Pseudomonas aeorginosa, H. influenza and Moraxella catarrhalis, e.t.c., germs is also responsible for chronic ear infections. Viruses like respiratory synctial virus which cause the common cold also lead to chronic middle ear infections. These infections can develop super infection by bacteria and can be associated with perforation when long standing. Using pins or needles, e.t.c. objects for scratching inside the ears, recurrent cold and sneezing , presence of water in the ear as occurs during a shower or swimming are some of the common risk factors for causing chronic infections of the ear. As pus builds up behind the ears it causes intense pain in the ear. As the quantity of pus increases, there is a visible purulent discharge. These symptoms may be associated with headache and high fever. Untreated, the infection may spread to the brain infecting the brain substance and its coverings. It can spread to the lungs causing pneumonia. Via blood stream, the infection can become generalized resulting in septicemia. Long standing infection damages the inner ear causing deafness. CSOM is a major cause for preventable deafness in young adults. A person of any age or gender can develop CSOM, if he has chronic infection of the middle ear. Children are more susceptible as they have a short length of eustachian tube (tube connecting throat and middle ear). Bottle feeding done with the toddler in a supine position, is another risk factor in children. Once these children develop a chronic middle ear infection, they are prone to develop CSOM unless treated adequately. The typical chronic earache along with pus discharge, points the diagnosis to be chronic suppurative otitis media. Through an otoscope, inflammation of the middle ear and perforation of the tympanic membrane can be seen. The microbes responsible for the infection can be identified by means of microscopic examination and culture of the pus discharge. Adequate course of a suitable antibiotic in form of tablets or local ear drops helps in healing of the infection. Chronic and resistant infections need surgical intervention. One can prevent developing CSOM rather than suffering from the resultant pain and discomfort. The ear should not be pricked in any way. Similarly, it is important to keep the ears dry. While swimming or taking a shower, ears should be plugged with cotton or other means like using a shower cap should be adopted to prevent ears from becoming damp. Protection of the ears against droughts of cold or hot air also helps in avoiding inflammation and infection of the middle ear. Steam inhalation done regularly is useful in curing symptoms of common cold. It also helps in preventing inflammation and congestion of the ear internally. Breast feeding as far as possible is healthy for children as compared to bottle feeding. If at all necessary to bottle feed, the baby should not be supine with head flat on the bed as this tends to cause ear infections. On experiencing any itching or pain with or without discharge in the ear, it is wise to consult and take adequate treatment before development of CSOM. E-mail-rachna212002@yahoo.co.uk