Current management of chronic suppurative otitis media in infants and children.

Most children who have chronic suppurative otitis media require: (1) a thorough examination of the external canal and tympanic membrane with the otomicroscope (under general anesthesia, if necessary); (2) a Gram stain and culture obtained directly from the middle ear; (3) thorough aspiration of the ear canal and, if possible, the middle ear, i.e. "aural toilet"; (4) treatment with an orally administered antimicrobial agent and an ototopical medication, if the organisms are susceptible; and if the suppurative process is unresponsive to this management, hospitalization and the parenteral administration of an antimicrobial agent. Parenteral antimicrobial therapy should be selected following microbiologic assessment of the discharge. If the infection can be eliminated using the methods described above, prevention of recurrence can be achieved by the following options: (1) prophylactic antimicrobial therapy; (2) removal of the tympanostomy tube; or (3) surgical repair of the tympanic membrane defect. The choice of these options depends on the age of the child and the status of the function of the eustachian tube. Middle ear and mastoid surgery should be reserved for those children who fail to respond to intensive medical therapy.