Treatment of Chronic Suppurative Otitis Media in Adults with Chronic Wet Ear Discharge

This protocol applies to adults diagnosed with chronic suppurative otitis media (CSOM) without suspected cholesteatoma who present with a chronically discharging (wet) ear.

Clinical Scenario

When chronic suppurative otitis media presents with persistent ear discharge rather than a dry ear, the infection is likely to be polymicrobial. This distinction — wet versus dry ear — determines which treatment pathway is appropriate. Cholesteatoma has been ruled out in this scenario.

First-Line Approach

Initial management begins with aural toilet to clear the ear canal of debris, followed by a combination of both topical and oral fluoroquinolone agents. The complete regimen, including the specific agents and their sequencing, is available in the full protocol.

Goal: Resolution of otorrhea

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References

Chronic suppurative otitis media without suspected cholesteatoma can be treated based on whether the ear is typically dry or wet (chronic discharge).
Chronic suppurative otitis media with a chronic discharging (wet) ear is likely to be polymicrobial (especially P. aeruginosa), therefore, initial treatment requires a combination of topical and oral fluoroquinolones.
Treatment is considered to have failed if otorrhea continues after three weeks of therapy.

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