Predisposing factors

The factors which predispose to a chronic suppurative otitis media include:

• an otitis media that was not promptly treated
• inappropriate or inadequate antibiotic therapy
• sepsis in the upper airway
• lowered resistance to infection, e.g. immunodeficiency, malnutrition, anaemia
• infection with a particularly virulent virus, e.g. measles

Some populations are considered to be at high risk of CSOM:

• high prevalence of disease among Indigenous people such as:
  • the Aboriginal and Torres Strait Islander Australian, Native American and Inuit populations - likely due to an interplay of factors, including socio-economic deprivation and possibly differences resulting from population genetics
• individuals with primary or secondary immunodeficiency are also susceptible to CSOM
• children with craniofacial malformation (including cleft palate) or chromosomal mutations such as Down syndrome are prone to chronic non-suppurative otitis media ('glue ear'), and by extrapolation may also be at greater risk of suppurative otitis media
  • association with craniofacial malformation may be related to altered function of the Eustachian tube, coexistent immunodeficiency, or both
• children who have a grommet (ventilation tube) in the tympanic membrane to treat glue ear or recurrent acute otitis media may be more prone to develop CSOM

Reference:

• Brennan-Jones CG et al. Topical antibiotics for chronic suppurative otitis media. Cochrane Syst Reviews January 2020
• Verhoeff M et al. Chronic suppurative otitis media: a review. Int J Pediatr Otorhinolaryngol 2006 Jan;70(1):1-12