Chronic suppurative otitis media

• Infected middle ear
• perforated TM
• discharge at least 6 weeks
• Can lead to intracranial infection, acute mastoiditis

Management

• Topical Abx alone
  • Ciprofloxacin 0.3% % drops 12hrly
    • 2-4 times a day after dry mopping or syringing
    • Continue until ear dry for at least 3 days
    • Advise to keep ear as dry as possible
  • Avoid aminoglycoside – auditory + vestibular toxicity
• Education for AOM with perforation –
  • Show families/caregivers:
    • How to clean/dry mop the ears with correctly prepared tissue spears
    • How to maximise effects of ear drops by ‘tragal pumping’
  • Tell the families/caregivers that:
    • Their child needs the medications as prescribed to prevent CSOM
    • About the likelihood of temporary hearing loss
    • It is important to go to the health centre if they have concerns about language development.

• Persistent CSOM = after 4 months of treatment
  • Add oral trimethoprim / sulfamethoxazole dose (8 mg / kg 2 times a day for 6-12 weeks)  if perforation size becomes too small for drops
  • Consider hospital admission for IV or IM treatment
  • Review weekly
  • Refer for ENT assessment
  • Refer for a hearing assessment