Treatment

It suggested that suspected chronic suppurative otitis media (CSOM) in primary care then (1):

• if diagnosis of CSOM is suspected then do not swab the ear or initiate treatment
• referral for ENT assessment is indicated

Subsequent management:

• management of safe, chronic otitis media depends on whether or not the ear is discharging. Surgical repair is not always needed
• a discharging ear requires regular aural toilet and antibiotics. A swab should be sent for culture as it may modify antibiotic choice. Tympanic perforation may heal, especially if small. Persistent discharge may warrant hospital admission for regular aural toilet.
• a non-discharging ear may be repaired surgically by some form of tympanoplasty. If repair is restricted to the tympanic membrane, it is described as a myringoplasty. If the ossicular chain needs to be reconstructed, then some form of ossiculoplasty is necessary. Usually, the patient's own temporalis fascia is used
• surgical repair may be indicated for occupational reasons, to allow swimming, or simply because the patient is fed up with the discharge. However, due consideration must always be given to the slight risk of sensorineural deafness which accompanies any operation on the ear

Reference:

• CKS (Accessed 12/8/2020). Chronic Suppurative Otitis Media.