Chronic otitis media in children: an evidence-based guide for diagnosis and management

Aim: To provide an easy-to-follow evidence-based diagnostic and therapeutic algorithm for the management of chronic otitis media (COM) in children.

Materials/methods: Literature review and critical analysis of the available evidence in Medline and other scientific database sources.

Data synthesis: Otorrhea and hearing loss are the cardinal symptoms of COM, while oto-microscopy and imaging techniques can confirm the diagnosis. Conservative treatment is acceptable to some extent (i.e. mild cases of COM without cholesteatoma). It involves topical drops (quinolones as first choice drugs- strength of recommendation B), as well as performing aural toilet (strength of recommendation B), and avoiding water ingress. Tympanoplasty without mastoidectomy is expected to improve hearing in cases of non-cholesteatomatous COM (strength of recommendation C), and positively affect the children's quality of life (strength of recommendation B). Less experienced surgeons and inflamed, wet middle ear mucosa represent the two most important factors, which could lead to reperforations (strength of recommendation C). The surgical management of COM with cholesteatoma tends to employ the least invasive surgical technique, in order to obtain a small self-cleaning mastoid cavity, as well as good hearing results (strength of recommendation C).

Conclusion: The treatment of choice in most cases of pediatric COM is surgery. Figure 1 proposes a detailed and easy-to-follow evidence-based algorithm with regard to the diagnosis and management of COM in children.