CSOM or Chronic Suppurative Otitis Media, is a long-lasting infection of the middle ear. It is usually associated with a hole or perforation in the eardrum and repeated or persistent discharge from the ear.
Unlike a short-term ear infection, CSOM can continue for a prolonged period and may cause problems such as hearing loss if it is not properly treated.
Because CSOM can damage structures inside the ear, persistent ear discharge or hearing problems should be evaluated by an ENT specialist.
What Is CSOM?
CSOM is a chronic form of middle ear infection. It commonly involves:
- Infection or inflammation of the middle ear
- A perforated eardrum
- Repeated or persistent discharge from the ear
- Possible hearing loss
The condition may develop after repeated episodes of acute middle ear infection or when an infection does not completely clear.
Symptoms of CSOM
The symptoms can vary depending on the severity and duration of the infection.
Ear Discharge
One of the most common symptoms is fluid or pus coming from the ear. The discharge may have an unpleasant smell and may occur repeatedly.
Hearing Loss
Hearing may become reduced because fluid, inflammation or damage to the middle ear can interfere with the normal movement of sound.
In children, hearing loss may sometimes be noticed through changes in behaviour, such as not responding to quiet sounds or turning the television volume up.
Ear Pain
Ear pain can occur, although chronic ear infections do not always cause severe pain. Sudden or severe pain may indicate an active infection or another ear problem.
Fever and Feeling Unwell
Acute middle ear infections may cause fever, tiredness, irritability and a general feeling of being unwell. These symptoms are more common during an active acute infection than in long-standing CSOM.
Balance Problems
Some people may experience dizziness or problems with balance when an ear infection affects structures involved in balance.
Symptoms in Children
Ear infections are particularly common in children. Young children may not be able to explain their symptoms clearly.
Possible signs include:
- Pulling or rubbing the ear
- Irritability
- Crying more than usual
- Difficulty sleeping
- Poor feeding
- Fever
- Cough
- Runny nose
- Diarrhea
- Reduced response to sounds
- Turning the television volume up
- Problems with balance
Parents should arrange a medical evaluation if a child has persistent ear discharge, hearing difficulties or repeated ear infections.
What Causes CSOM?
CSOM often develops following repeated or persistent middle ear infections.
Bacterial or Viral Infections
Many middle ear infections occur when bacteria or viruses spread from the nose and throat into the middle ear.
A common cold or other respiratory infection can contribute to blockage of the Eustachian tube, allowing fluid to build up in the middle ear.
Eustachian Tube Problems
The Eustachian tube connects the middle ear to the back of the nose and throat. It helps maintain normal pressure in the middle ear and allows fluid to drain.
When the tube becomes blocked, fluid can accumulate behind the eardrum. This can create an environment where infection develops.
Enlarged Adenoids
Enlarged adenoids can block the opening of the Eustachian tube, particularly in children. This may contribute to repeated middle ear infections.
Perforated Eardrum
A severe or repeated middle ear infection can cause the eardrum to develop a hole. Once the eardrum is perforated, fluid or pus may drain from the middle ear into the ear canal.
Sometimes this reduces pressure and temporarily relieves pain, but persistent discharge needs medical assessment.
Why Are Children More Prone to Ear Infections?
Children are more likely to develop middle ear infections partly because their Eustachian tubes are smaller and positioned differently from those of adults.
Children also commonly experience colds and respiratory infections, which can contribute to Eustachian tube blockage.
Enlarged adenoids can further increase the risk of repeated ear infections.
Risk Factors
Several factors may increase the risk of middle ear infections and related complications.
Daycare or Nursery Attendance
Children who spend time in daycare may have more exposure to respiratory infections because of close contact with other children.
Passive Smoking
Exposure to tobacco smoke can irritate the airways and increase the risk of respiratory and ear infections in children.
Not Being Breastfed
Breastfeeding may provide some protection against certain childhood infections. However, many factors influence the risk of ear infections, and not being breastfed does not mean that a child will develop CSOM.
Repeated Respiratory Infections
Frequent colds and other upper respiratory infections can contribute to Eustachian tube blockage and middle ear problems.
How Is CSOM Diagnosed?
An ENT specialist can diagnose CSOM by examining the ear and eardrum.
The doctor may use an otoscope to look for:
- A perforated eardrum
- Ear discharge
- Inflammation
- Changes in the middle ear
A hearing test may also be recommended to determine whether the infection has affected hearing.
In some cases, additional tests or imaging may be required, particularly when complications are suspected.
Treatment of CSOM
Treatment depends on the severity of the infection and the condition of the eardrum.
A doctor may recommend:
- Cleaning the ear when appropriate
- Antibiotic ear drops or other medicines
- Treatment of underlying nasal or throat problems
- Hearing assessment
- Surgery in selected cases
Do not put oil, water, or non-prescribed medicines into an ear with a perforated eardrum. Some ear drops may be unsafe when there is a hole in the eardrum, so treatment should be guided by a healthcare professional.
If enlarged adenoids or tonsils contribute to repeated infections, an ENT specialist may consider appropriate treatment.
Can CSOM Cause Hearing Loss?
Yes. Long-standing middle ear inflammation, fluid, or damage to the eardrum and middle ear structures can cause hearing loss.
In children, untreated hearing problems may affect speech, language development, learning, and communication.
For this reason, children with persistent ear discharge or suspected hearing loss should receive an appropriate hearing evaluation.
When Should You See a Doctor?
See a doctor or ENT specialist if you or your child has:
- Persistent or repeated ear discharge
- Hearing loss
- Repeated ear infections
- A known perforated eardrum
- Severe or persistent ear pain
- Fever with an ear infection
- Dizziness or balance problems
- Swelling around the ear
- Symptoms that are getting worse
Seek urgent medical attention if there is severe illness, significant swelling behind the ear, facial weakness, severe dizziness or sudden hearing loss.
Final Thoughts
CSOM is a long-term middle ear infection that can involve a perforated eardrum and persistent or repeated ear discharge. It may develop after repeated middle ear infections or problems with Eustachian tube drainage.
Children are particularly susceptible to middle ear infections because of the structure of their Eustachian tubes and the frequent respiratory infections they experience.
Early medical assessment is important when ear discharge or hearing loss persists. With appropriate treatment and follow-up, complications can often be reduced.
Disclaimer: This article is for general health information only and is not a substitute for professional medical diagnosis or treatment. If you have persistent ear discharge, hearing loss, severe ear pain or other concerning symptoms, consult a qualified doctor or ENT specialist.
Dr. Parminder Singh (BEMS) – Reg. No. 00933 (Chandigarh)
