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Chronic otitis media and tympanic membrane perforation
Chronic suppurative otitis media is recurrent or persistent discharge through a perforated eardrum; it is treated with cleaning and quinolone drops that are not toxic to the ear, and in a quiet phase the perforation is closed surgically (tympanoplasty) after cholesteatoma has been excluded.
Why it matters in the exam
Under the World Health Organization, chronic suppurative otitis media is discharge through a perforation for two weeks or more; many define 6 weeks or more. The usual bacteria are Pseudomonas aeruginosa and Staphylococcus aureus. The exam asks about the choice of drops: quinolone drops (ciprofloxacin or ofloxacin) are the choice when there is a perforation, because aminoglycoside drops can damage the inner ear. Cleaning the ear (aural toilet) before the drops is as important as the drug itself.
The distinction between a central perforation (relatively safe) and a marginal or pars flaccida perforation (dangerous, linked to cholesteatoma) sets the urgency. A traumatic perforation (slap, cotton bud, blast) usually closes on its own: over 80% close within 3 months if the ear is kept dry. A perforation that has not closed after 3 months, or that causes recurrent infections or hearing loss, is an indication for surgery.
Myringoplasty closes the eardrum only; tympanoplasty also inspects and repairs the ossicles. Usual grafts are temporalis fascia and cartilage (from the tragus or concha); cartilage is more durable in a large or recurrent perforation and with poor Eustachian tube function. Closure succeeds in about 85% to 90%. A conductive loss larger than about 40 dB with a small perforation suggests ossicular chain damage. A full hearing test is done before surgery, and the patient keeps the ear dry in the shower and when swimming until the graft has taken well.
Key points
- Discharge through a perforation for two weeks or more.
- Pseudomonas and S. aureus.
- Cleaning and quinolone drops.
- Marginal perforation → exclude cholesteatoma.
- Surgical closure in a quiet phase, success about 85% to 90%.
Summary table
| Situation | Clue | Approach |
|---|---|---|
| Central perforation with discharge | Discharge through a perforation, no retraction pocket | Cleaning and quinolone drops; surgery in a quiet phase |
| Marginal or pars flaccida perforation | Foul discharge, squames | CT; exclude cholesteatoma |
| Traumatic perforation | After a slap or cotton bud | Dry ear and follow-up for 3 months |
| Perforation that has not closed | 3 months or more, recurrent infections | Myringoplasty or tympanoplasty |
| Large conductive gap | Over 40 dB with a small perforation | Tympanoplasty with ossicular inspection |
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Sources
- WHO Chronic suppurative otitis media: burden of illness and management options, 2004 — Definition and treatment
- Cummings Otolaryngology: Head and Neck Surgery, 7th edition (2021) — Chronic otitis media and tympanoplasty
- Cochrane Review: Topical antibiotics for chronic suppurative otitis media, 2020 — Main results
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.