CLINICOPATHOLOGICAL PROFILE OF CHRONIC SUPPURATIVE OTITIS MEDIA IN A TERTIARY CARE TEACHING HOSPITAL: A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background:Chronic Suppurative Otitis Media (CSOM) is a persistent inflammatory condition of the middle ear and mastoid cavity, characterized by recurrent or continuous ear discharge through a tympanic membrane perforation lasting more than three months. It remains a substantial public health burden in developing countries including India, contributing to preventable hearing loss, school absenteeism, and socioeconomic disadvantage — particularly in resource-constrained rural populations. M.M. Institute of Medical Sciences & Research (MMIMSR), Mullana, Ambala, serves a predominantly agrarian catchment area spanning Ambala, Yamunanagar, and Kurukshetra districts of Haryana. The ENT department encounters a steady flow of CSOM cases, yet no systematic institutional documentation had characterized the clinical, microbiological, and management profile of these patients to guide evidence-based departmental protocols.

Objectives:To characterise the clinicopathological profile, bacteriological spectrum, and treatment outcomes of CSOM patients presenting to MMIMSR ENT department during March–August 2005; and to compare clinical features and complications between safe (tubotympanic) and unsafe (atticoantral) disease types.

Methodology:A retrospective observational study was conducted using medical records from the MMIMSR ENT OPD and ward admissions (March–August 2005). All patients with confirmed CSOM diagnosis were included. Data extracted included demographics, symptom profile, otoscopic findings, tympanic membrane perforation type, pure tone audiometry, microbiological culture results with antibiotic sensitivity, complications, and treatment outcomes. Safe and unsafe disease types were compared using chi-square/Fisher's exact and t-tests. Analysis performed using SPSS v12.0.

Results:186 patients (240 affected ears) were included: 110 male (59.1%), mean age 30.2±15.6 years. Safe (tubotympanic) type comprised 126 ears (52.5%); unsafe (atticoantral) type 114 ears (47.5%). All patients reported ear discharge; 95.7% had hearing loss (mean 54.8 dB). Unsafe type showed significantly longer disease duration (p=0.014), higher complication rates including cholesteatoma (28.1% vs 0%; p<0.001), mastoid abscess, and intracranial extension (8 cases total). Pseudomonas aeruginosa was the predominant isolate (80/158, 50.6%), followed by Staphylococcus aureus (44/158, 27.8%). Ciprofloxacin showed highest sensitivity (>85% across all organisms). 114 patients (61.3%) required surgical intervention; cortical mastoidectomy (38 cases) and tympanoplasty (32 cases) most common. Overall treatment success rate was 79.6%.

Conclusion:CSOM at MMIMSR presents predominantly in the 11–30 age group with high complication burden, particularly in unsafe disease. Pseudomonas predominance and fluoroquinolone sensitivity align with national patterns. Timely surgical intervention yields favourable outcomes. Routine microbiological surveillance, early surgical referral for unsafe disease, and community awareness programs in Ambala's rural blocks are recommended to reduce disease burden and prevent irreversible hearing loss in this vulnerable population.