Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment, disability, and poor scholastic performance, and can occasionally lead to fatal intracranial infections and acute mastoiditis, especially in resource-poor countries.

Methods and outcomes

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic suppurative otitis media in adults; and in children? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results

We found 48 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions

In this systematic review we present information relating to the effectiveness and safety of the following interventions: ear cleansing, systemic antibiotics, topical antibiotics, topical antiseptics, topical corticosteroids, tympanoplasty (with or without mastoidectomy).

Key Points

Chronic suppurative otitis media (CSOM) causes recurrent or persistent discharge (otorrhoea) through a perforation in the tympanic membrane, and can lead to thickening of the middle ear mucosa, mucosal polyps, and cholesteatoma.

1. CSOM is a common cause of hearing impairment, disability, and poor scholastic performance, and can occasionally lead to fatal intracranial infections and acute mastoiditis, especially in resource-poor countries.

Topical antibiotics either alone or in combination with topical corticosteroids may improve symptoms compared with placebo or either treatment alone in adults, although few adequate studies have been found. There is consensus that topical antibiotics should be combined with ear cleansing.

1. We don't know whether topical antiseptics, topical corticosteroids or systemic antibiotics are beneficial in reducing symptoms.
2. It is possible that antibiotics against gram negative bacteria may reduce ear discharge more than other classes of antibiotics or placebo.

We don't know whether tympanoplasty with or without mastoidectomy improves symptoms compared with no surgery or other treatments in adults or children with CSOM.

In children with CSOM, the benefits of ear cleansing are unknown, although this treatment is usually recommended for children with ear discharge.

1. We don't know whether topical antiseptics, topical or systemic antibiotics, or topical corticosteroids, alone or in combination with antibiotics, improve symptoms in children with CSOM compared with placebo or other treatments.
2. It is possible that topical antibiotics improve resolution of ear discharge compared with topical antiseptics, but they may increase the risk of ototoxicity.