1) Disease Description (Causes and Symptoms)
- Definition summary: Chronic otitis media is a condition in which chronic inflammation persists in the mucous membrane of the middle ear behind the eardrum, causing a perforated eardrum (hole), persistent or recurrent ear discharge (fluid/pus), hearing loss, and other symptoms.
- Main causes: The main causes include poor middle-ear ventilation due to dysfunction of the auditory tube (Eustachian tube), recurrent bacterial infections, and ongoing tissue destruction caused by cholesteatoma.
- Pathophysiology: When auditory tube dysfunction causes poor middle-ear pressure regulation and ventilation, mucosal inflammation persists or resident bacteria multiply, resulting in recurrent eardrum perforation and discharge. If cholesteatoma is present, destruction of the middle-ear and mastoid bones and expansion of inflammation may progress.
- Main symptoms: Persistent or recurrent ear discharge (pus or foul odor), hearing loss (conductive or mixed), and tinnitus. Pain, severe dizziness, and facial paralysis are uncommon; when they occur, they may indicate complications.
2) Treatment Methods
- Conservative treatment
- Removal of discharge through ear canal and middle-ear cleaning (suction and irrigation by medical staff).
- Topical antibiotics (ear drops, usually drops containing an antimicrobial agent) are used as the first-line treatment.
- If there is a large amount of discharge or systemic symptoms, oral or intravenous antibiotics may be used according to the results of bacterial cultures.
- Treatment related to the nose and auditory tube to control inflammation (treatment for allergies or sinusitis, nasal sprays, etc.) may be provided concurrently.
- Surgical treatment
- Performed with the goal of definitive removal: tympanoplasty, mastoidectomy and removal of cholesteatoma, dissection and cleaning of the mastoid and middle ear, and reconstruction of the sound-conducting system (ossicular chain) (ossiculoplasty), among others.
- The extent and method of surgery are determined according to the extent of inflammation, whether cholesteatoma is present, hearing status, and other factors.
- Hearing assistance
- If hearing remains impaired after surgery or reconstruction is difficult, the use of hearing aids or hearing devices (such as bone-conduction hearing aids) may be considered.
- Lifestyle management and precautions
- Do not expose the ear directly to water (protect the ear when swimming or showering); do not insert foreign objects such as cotton swabs.
- Do not smoke (smoking can worsen upper-airway and auditory tube function).
- Prevent worsening of otitis media through early treatment of colds and upper respiratory infections.
- Warning (emergency signs)
- Immediate emergency evaluation is necessary if sudden severe dizziness, rapidly worsening hearing loss, facial nerve paralysis, high fever, or altered consciousness occurs.
3) Checklist Before an Outpatient Visit (Items to Bring and Things to Confirm Before the Appointment)
- Items/materials to bring
- A list of current medications (including prescription and nonprescription medicines and supplements) and allergy information.
- Previous otolaryngology medical records and records of past surgeries (including ear surgery).
- Results of previous hearing tests (pure-tone audiometry) and imaging results such as temporal bone CT or MRI, if available (the original or a CD).
- A record of symptoms over the past several days (color, amount, and odor of discharge; presence of fever; changes in hearing; presence of dizziness, etc.) and the date and frequency of symptom onset.
- Self-check items before the appointment
- Color of the discharge (clear fluid/serous fluid/pus), presence of odor, and presence of bleeding.
- Presence and severity of pain and whether there is a fever.
- Any abnormal facial muscle movement (such as one side of the mouth drooping) or severe dizziness.
- Example questions (that can be used during the appointment)
- Has the discharge been occurring more frequently recently, or has the odor become stronger?
- Have you previously had a hearing test or CT scan? (If so, present the results.)
4) Examples of General Questions to Ask the Doctor
- "Do I need surgery (tympanoplasty/mastoid surgery) for my current condition? If so, what are the expected benefits and risks?"
- "What are the side effects and duration of use of the antibiotic (or ear drops) you plan to prescribe?"
- "What is the expected outlook for my current hearing status (possibility of recovery)? What is the long-term prognosis?"
- "What precautions should I take in daily activities (swimming, showering, air travel, etc.)?"
- "What lifestyle habits and preventive measures can help reduce recurrence?"
5) Examples of Condition-Specific Questions
- "How is the presence of cholesteatoma confirmed, and if it is present, what type of surgery is recommended?"
- "What are the size and location of the current eardrum perforation, and how likely is hearing recovery with tympanoplasty?"
Note: This information is general medical information and is not a substitute for diagnosis or treatment. If symptoms are severe or emergency signs are present, visit a medical institution immediately.