This protocol applies to pediatric patients aged 6 months and older, as well as adults, presenting with chronic suppurative otitis media (CSOM) in which the ear is currently dry — no chronic discharge — and cholesteatoma is not suspected.
CSOM without suspected cholesteatoma can be managed differently depending on whether the ear is dry or chronically discharging. A dry ear presentation is likely driven by pathogens similar to those responsible for acute otitis media, which directly informs the treatment approach.
Management combines mechanical cleaning of the external ear canal with targeted topical antibiotic therapy. Evidence indicates that patients with CSOM respond more frequently to topical treatment than to systemic therapy, provided regular canal cleaning accompanies it. The specific agent, schedule, and full regimen are detailed in the complete protocol.
The primary clinical target is resolution of otorrhea. Follow-up is recommended at seven days and weekly thereafter to assess response; treatment is considered to have failed if otorrhea persists after three weeks of therapy.