CHRONIC SUPPURATIVE OTITIS MEDIA – ETIOPATHOGENESIS, EPIDEMIOLOGY, CLASSIFICATION AND DIAGNOSIS

Abstract

Objectives. To develop a narrative synthesis regarding the etiology, pathogenesis, epidemiology, classification, and diagnosis of chronic suppurative otitis media.

Methods. Scientific publications from the databases PubMed, Hinari, SpringerLink, National Center of Biotechnology Information, and Medline were reviewed to evaluate the etiopathogenesis, epidemiology, classification, and diagnosis of patients with chronic suppurative otitis media, using the keywords: “chronic otitis media”, “chronic suppurative otitis media”, “etiology”, “pathogenesis”, “epidemiology”, “classification”, “diagnosis”, “complications” and “prognosis.” A total of 26 relevant and representative bibliographic sources were selected, covering materials published on the topic of this review article.

Results. In developed countries, the prevalence of chronic suppurative otitis media is relatively low (<1%), whereas in low-income countries, it ranges from 7% to 46%. The causative pathogens include aerobic bacteria (Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Escherichia coli), anaerobic bacteria (Bacteroides spp., Clostridium spp., Prevotella spp.), or fungal infections (Aspergillus spp. and Candida spp.). The diagnosis of chronic suppurative otitis media is based on a combination of clinical history, otoscopic examination, audiological assessment, and imaging studies. The complications of the disease are classified as extracranial and intracranial. Chronic suppurative otitis media causes mild conductive hearing loss (an increase of approximately 10–20 dB in hearing thresholds) to moderate hearing loss (an increase of approximately 50–70 dB in hearing thresholds) in 50–60% of cases, due to tympanic membrane perforation and reduced mobility, effusion, and/or discontinuity of the ossicular chain.

Conclusions. Chronic suppurative otitis media is a chronic inflammatory process located in the middle ear system, resulting from an initial episode of acute otitis media. It is characterized by continuous or intermittent purulent otorrhea, persistent tympanic membrane perforation, and progressive conductive or mixed hearing loss.