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1. Chronic otitis media includes cholesteatoma and chronic draining ears, typically with mastoid disease. These all require specialty consultation.
   
   
2. Antibiotics:

    

   Amoxicillin	250-500 mg p.o. tid x 7-10 days
   or
   Pen V.K.	500 mg p.o. qid x 7-10 days
   or
   Erythromycin	250 mg p.o. qid x 7-10 days
   	333 mg p.o. tid

    

3. Ear drops:

   Floxin Otic or Cipro HC, ii gtts qid

   Many antibiotic ear drops are available. Current thinking is that the polymixins and aminoglycosides are ototoxic and may cause sensorineural hearing loss in the presence of a tympanic membrane perforation. The quinolone drops are therefore the only safe topical antibiotic in the presence of a tympanic membrane perforation.

   
   

4. Audiogram: assuming a correct diagnosis, an audiogram will be required when the ear is dry (not infected and draining). If you order an audiogram when the ear is infected, the audiogram will need to be repeated when the ear is dry.
   
   
5. The cost of not referring chronic otitis media is recurrent infection with ever diminishing hearing. Further risks are meningitis, facial paralysis, brain abscess and deafness.

Overview of Chronic Otitis Media

Chronic otitis media is any inflammatory middle ear or mastoid malady. At a minimum this causes conductive hearing loss and recurrent infection. More commonly, it causes recurrent infection with ever increasing scarring to the middle ear and at its worst causes serious and even fatal complications such as meningitis, brain abscess and death. This is a disease which requires specialty consultation.

If specialty consultation is not immediately available, p.o. antibiotics, antibiotic containing eardrops should be administered. When the ear is free of infection, an audiogram, is appropriate and necessary.