Chronic
suppurative otitis media is
characterized by persistent or recurrent purulent otorrhea in the setting of
tympanic membrane perforation. Usually, there is also some degree of conductive
hearing loss. This condition is sometimes divided into two subcategories: active
and inactive. Inactive disease is characterized by a central perforation of the
tympanic membrane, which allows drainage of purulent fluid from the middle ear.
When the perforation is more peripheral, squamous epithelium from the auditory
canal may invade the middle ear through the perforation, forming a mass of
keratinaceous debris (cholesteatoma) at the
site of invasion. This mass can enlarge and has the potential to erode bone and
promote further infection, which can lead to meningitis, brain abscess, or
paralysis of cranial nerve VII. Treatment of chronic active otitis media is
surgical; mastoidectomy, myringoplasty, and tympanoplasty can be performed as outpatient
surgical procedures, with an overall success rate of _80%. Chronic inactive otitis media is more difficult
to cure, usually requiring repeated courses of topical antibiotic drops during
periods of drainage. Systemic antibiotics may offer better cure rates, but
their role in the treatment of this condition remains unclear.
Source:
Harrison_s_Principles_of_Internal_Medicine_16th_Edition
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