Synopsis
Evaluate persistent or recurrent discharge through a chronic tympanic perforation, control local infection safely and address hearing loss while excluding destructive middle-ear disease.
- Chronic suppurative otitis media involves persistent or recurrent drainage through a longstanding tympanic membrane perforation.
- A perforation can also be dry and inactive; it does not require antibiotics merely because a hole remains.
- Establish whether discharge comes from middle-ear mucosa, the external canal or a cholesteatoma.
Key red flags
New facial asymmetry, severe vertigo or rapidly worsening hearing can indicate damage beyond the chronically inflamed middle-ear lining.
Investigation priorities
Guide treatment when infection persists or repeatedly returns.
Management branches
Discharge is consistent with uncomplicated mucosal infection through a chronic perforation.
- Inspect adequately, obtain culture where appropriate and arrange trained aural cleaning when debris prevents assessment or drug delivery.
- Use a topical preparation selected for the open middle ear under the local ENT or prescribing pathway, explaining any off-label use.
Key medicines
Ciprofloxacin with dexamethasone for selected active CSOMUse an ENT-directed off-label CSOM prescription that specifies the exact preparation, number of drops, frequency and review or stop date. GGC recommends this combination for discharging chronic mucosal disease but does not publish a fixed CSOM course. For formulation reference only, the 3 mg/mL plus 1 mg/mL generic SmPC specifies four drops twice daily for seven days for acute otitis externa; this is not GGC-endorsed CSOM dosing.