Chronic Suppurative Otitis Media

Chronic suppurative otitis media is a long-standing infection of the middle ear associated with a persistent perforation of the eardrum and ongoing or recurrent ear discharge, often following repeated or poorly treated acute ear infections in childhood.

• Persistent or recurrent ear discharge, often for more than two weeks, usually painless
• Hearing loss in the affected ear
• A visible perforation (hole) in the eardrum on examination
• Discharge may have an unpleasant odour

• Usually follows repeated episodes of acute otitis media that did not heal completely, leaving a persistent perforation that allows ongoing infection.
• Risk is increased by frequent childhood ear infections, poor access to care, malnutrition, and overcrowded living conditions.

• Diagnosed by examining the ear (otoscopy) and finding a perforated eardrum with discharge or a moist ear canal.
• Hearing assessment helps document the degree of hearing loss.
• Persistent cases, or those with a foul-smelling discharge, deep-seated pain, or signs of spreading infection, are assessed further for possible complications.

Regular and careful ear cleaning (aural toilet) — gently wicking away discharge with clean, dry cloth or cotton wicks — is an important part of treatment and should be done several times a day until the ear is dry.

Topical antibiotic ear drops (such as ciprofloxacin drops) are used to control the infection and are generally preferred over oral antibiotics for this condition.

Keeping the ear dry, including avoiding water entering the ear canal during bathing or swimming, supports healing.

Persistent perforation once the infection is controlled, or hearing loss affecting daily life, is referred for specialist ear assessment, which may include consideration of surgical repair of the eardrum.

Signs of spreading infection — such as swelling behind the ear, severe headache, or facial weakness — require urgent referral, as these can indicate a serious complication.

• Ensure prompt and complete treatment of acute ear infections in children to reduce the risk of chronicity.
• Keep the ear dry, particularly during bathing and swimming, once a perforation is present.
• Avoid inserting objects such as cotton buds into the ear canal.
• Seek regular follow-up for chronic ear discharge rather than treating it as a minor, ongoing nuisance.