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(CSOM, chronic active mucosal otitis media, chronic oto-mastoiditis, chronic tympanomastoiditis) Chronic inflammation of the middle ear and mastoid cavity. The patients have tympanic membrane perforation (ear drum rupture) where otorrhoea continues for periods of from 6 weeks to 3 months, despite medical treatment. It usually begins in childhood and found especially in developing countries. The infection may occur during the first 6 years, with a peak around 2 years. Thickened granular middle ear mucosa and mucosal polyps are typically found. Cholesteatoma is occasionally found. It is an abnormal accumulation of squamous epithelium usually found in the middle ear cavity and mastoid process of the temporal bone. Granulation tissue and ear discharge are often associated with secondary infection of the desquamating epithelium. Types • active CSOM: Recurrent bouts of otorrhoea. • inactive CSOM: Dry but permanent tympanic perforation, often with areas of retraction and scarring in the eardrum which do not vibrate in response to sound, as well as normal areas. Causes • acute infection of the middle ear (acute otitis media with perforation or a sequel of less severe forms of otitis media) • blockage of the eustachian tube • injury to the ear (a slap to the ear, a cotton swab injury, a severe blow to the head in an accident) Complications • hearing impairment, disability • poor scholastic performance • fatal intracranial infections, acute mastoiditis Treatment • topical antibiotics (e.g. quinolone antibiotics) (alone or in combination with topical corticosteroids) • aural toileting (cleaning the ear): dry mopping (with cotton wool or tissue paper), irrigation (using ear syringing), suction clearance (typically under a microscope) • surgery in severe cases