Chronic Suppurative Otitis Media | CSOM

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Chronic Suppurative Otitis Media or CSOM is a long standing infection of a part or whole of the middle ear cleft characterized by Ear discharge and a permanent Perforation. A perforation becomes permanent when it’s edges are covered by squamous epithelium and it does not heal spontaneously. A permanent perforation can be likened to an epithelium-lined fistulous track.

Word wise Meaning of CSOM:

  • Chronic- Long standing
  • Suppurative- Related with pus (containing or discharging pus)
  • Otitis- Inflammation of ear
  • Media- Middle ear

Types of CSOM

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Clinically, it can be divided into two types:-


  • Also called the safe or benign type.
  • It involves anteroinferior part of middle ear cleft ,i.e, eustachian tube and mesotympanum.
  • It is associated with central perforation.
  • There is no risk of serious complication.


  • Also called unsafe or dangerous type.
  • It involves posterosuperior part of middle ear cleft, i.e, attic, antrum and mastoid.
  • It is associated with an attic or marginal perforation.
  • This disease is often associated with a bone-eroding process such as cholesteatoma, granulation or osteitis and risk of complication is very high.

Difference between Atticoantral and Tubotympanic CSOM

tubotympanic vs atticoantral csom
Difference between Tubotympanic and Atticoantral CSOM
Features Tubotympanic Atticoantral
Discharge Profuse Mucoid




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Foul Smelling

Perforation Central Attic/Marginal
Granulation Uncommon Common
Polyp Pale Red and fleshy
Cholesteatoma Absent Present
Complications Rare Common
Audiogram Mild to moderate conductive deafness Conductive deafness or mixed deafness
polyp in ear canal csom
Polyp in Ear Canal in CSOM

This was general about Chronic Suppurative Otitis Media. There are its two types- Tubotympanic and Atticoantral CSOM.

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