GuidelinesPEML (Paeds Hospital STG)
Otitis Media, Chronic, Suppurative
Otitis media, chronic, suppurative
General and supportive measures
ICD-10 code: H66.1, H66.2, H66.3
DESCRIPTION
A purulent discharge from the middle ear with perforation of the ear drum for more than two weeks.
Note: TB is a rare cause of a chronic discharge from the ear.
Persistent or chronic otitis media is also associated with HIV infection in children.
GENERAL AND SUPPORTIVE MEASURES
- Dry mopping is the most important part of the treatment. It should be demonstrated to the child’s caregiver or patient if old enough.
- Continue with dry mopping for 4 weeks.
- Then dry the canal as much as possible with paper towel twisted into a wick.
- Then frequently instil acetic acid 2% ear drops, 4 drops, 4 times daily for 5 days.
- Avoid getting the inside of the ear wet during swimming and bathing by using earplugs only during these activities.
MEDICINE TREATMENT
- Fluoroquinolone ear drops, e.g.:
- Ciprofloxacin ear drops, instil 2 drops, 8 hourly into the affected ear after dry mopping.
REFERRAL
Emergency
- All with suspected intracranial complication.
Elective (referral to ENT specialist)
- Suspected cholesteatoma.
- Persistent tympanic membrane perforation.
- No improvement after 4 weeks.
- Further antimicrobial choices should be based on definitive diagnosis based on culture and sensitivity.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 17: Ear Nose & Throat, 17.9 Otitis Media, Chronic, Suppurative