Chronic Suppurative Otitis Media in Adolescents: Risk Factors, Clinical Manifestations, and Management.

Abstract

Background
Chronic Suppurative Otitis Media (CSOM) is a persistent infection of the middle ear. It is
characterized by recurrent or continuous otorrhea through a perforated tympanic membrane. It
remains a significant cause of preventable hearing impairment, particularly in developing countries.
This report highlights the risk factors, clinical presentation, diagnosis, management and outcome of
CSOM in an adolescent patient with identifiable modifiable risk factors.
Case Report
A 15-year-old male presented to the Ear, Nose and Throat outpatient clinic of Pelabuhan Hospital,
North Jakarta with two-month history of right-sided ear pain, ear discharge, aural fullness, tinnitus
and progressive hearing loss. The patient reported frequent swimming and habitual ear cleaning with
cotton swabs. Otoscopic examination revealed purulent otorrhea, hyperemia of the external auditory
canal and a central perforation of the pars tensa with mucopurulent discharge. Pure-tone audiometry
demonstrated mild-to-moderate conductive hearing loss in the affected ear, while the contralateral ear
was normal. A diagnosis of right-sided tubotympanic (safe type) CSOM was made. Patient was
managed by aural toilet, 3% hydrogen peroxide ear drops, topical ofloxacin, oral erythromycin.
Additionally counseling regarding prevention of water entry particularly in affected ear and avoidance
of ear canal manipulation was also done. At two-week follow-up, the patient showed marked
symptomatic improvement, with significant reduction in otorrhea, otalgia, and tinnitus. Additionally
subjective improvement in hearing was reported.
Conclusion
This case emphasizes the contribution of modifiable behavioral risk factors, particularly frequent
water exposure and cotton-swab use, in the development of CSOM among adolescents. Early
diagnosis, audiometric assessment, appropriate antimicrobial therapy and preventive education can
result in favorable clinical outcomes and help prevent long-term auditory sequelae.