Chronic suppurative otitis media (CSOM) is a persistent infection of the middle ear cleft characterized by recurrent otorrhea through a tympanic membrane perforation. It continues to be a significant public health issue, especially in low- and middle-income countries, where overcrowding, poor hygiene, malnutrition, and limited access to healthcare sustain its burden [1,2]. Globally, CSOM affects an estimated 65–330 million individuals, and nearly half of these patients suffer from clinically significant hearing impairment, adversely impacting speech, language development, education, and overall quality of life [2,3]. Clinically, CSOM is broadly classified into two types. The tubotympanic (safe) type typically involves the anteroinferior quadrant of the tympanic membrane and generally has a benign course, while the atticoantral (unsafe) type is often associated with cholesteatoma and a higher risk of life-threatening complications [3,4]. The disease usually presents with persistent or recurrent ear discharge and varying degrees of hearing loss. When inadequately treated, it can progress to extracranial complications such as mastoiditis, labyrinthitis, and facial nerve palsy, or intracranial complications including meningitis, lateral sinus thrombosis, and brain abscess [4,5]. Despite advances in antimicrobial therapy and otologic surgery, CSOM remains one of the most common causes of preventable hearing loss in developing nations. Timely diagnosis, appropriate management, and improved community awareness are crucial for reducing the risk of complications and long-term morbidity [1–5]. The present study was undertaken to evaluate the clinical profile of patients with CSOM and to analyze the spectrum of complications encountered in a tertiary care hospital. The present study was undertaken to evaluate the clinical profile of patients with CSOM and to analyze the spectrum of complications encountered in a tertiary care hospital.

Study Design and Setting: This was a hospital-based cross-sectional observational study conducted in the Department of E.N.T, Government Medical College and Government General Hospital, Rajanna Siricilla, Telangana. The study was carried out over a period of nine months, from November 2024 to July 2025. Study Population: A total of 100 patients clinically diagnosed with chronic suppurative otitis media (CSOM) attending the outpatient and inpatient services of the department during the study period were included. Both male and female patients across all age groups were considered. Inclusion Criteria: Patients of all ages with a clinical diagnosis of CSOM. Patients with a history of ear discharge persisting for more than three months. Patients willing to provide informed consent. Exclusion Criteria: Patients with acute otitis media, otitis externa, or otitis media with effusion. Individuals with prior ear surgery. Patients with systemic illnesses affecting hearing (e.g., diabetes mellitus, immunodeficiency, tuberculosis). Unwilling or uncooperative participants. Data Collection: Detailed demographic and clinical history was obtained, including age, gender, duration of ear discharge, hearing loss, and other associated symptoms. All patients underwent a complete ear, nose, and throat examination using otoscopy and microscopic evaluation. Pure tone audiometry was performed to assess the type and degree of hearing loss. The disease was classified into tubotympanic (safe) and atticoantral (unsafe) types. Assessment of Complications: Patients were examined for extracranial complications (mastoiditis, facial nerve palsy, labyrinthitis) and intracranial complications (meningitis, intracranial abscess). Radiological investigations, such as X-ray mastoids and computed tomography (CT) temporal bone, were performed in selected cases to confirm complications. Statistical Analysis: Collected data were compiled and analyzed using SPSS version 26.0. Descriptive statistics such as mean, standard deviation, and percentages were applied. Results were presented in the form of tables and charts for clarity. Ethical Considerations: The study protocol was approved by the Institutional Ethics Committee of Government Medical College, Rajanna Siricilla. Informed consent was obtained from all participants or their guardians in case of minors.

A total of 100 patients with chronic suppurative otitis media (CSOM) were included in the study. The mean age of presentation was 27.4 ± 12.8 years, with the majority belonging to the 11–30 year age group (52%). Children under 10 years constituted 14%, while patients above 50 years represented only 6%. Males (58%) outnumbered females (42%), giving a male-to-female ratio of 1.38:1. The most consistent symptom was ear discharge, present in all patients (100%), followed by hearing loss in 88%, earache in 36%, tinnitus in 18%, and vertigo in 10% (Table 1). Table 1. Demographic and Clinical Profile of CSOM Patients (n = 100) Parameter Sub-category Frequency (%) Age (years) ≤10 14 (14%) 11–30 52 (52%) 31–50 28 (28%) >50 6 (6%) Gender Male 58 (58%) Female 42 (42%) Symptoms Ear discharge 100 (100%) Hearing loss 88 (88%) Earache 36 (36%) Tinnitus 18 (18%) Vertigo 10 (10%) With regard to disease type, the tubotympanic (safe) variety was the most prevalent, accounting for 68% of cases, whereas the atticoantral (unsafe) type was found in 32% of patients. Hearing loss was predominantly conductive (72%), while 16% had mixed hearing loss. Twelve patients (12%) did not report any measurable hearing impairment. The mean pure tone average was 32.5 ± 8.2 dB, indicating a moderate degree of conductive deficit (Table 2). Table 2. Distribution of CSOM Types and Hearing Loss Variable Category Frequency (%) Type of CSOM Tubotympanic (safe) 68 (68%) Atticoantral (unsafe) 32 (32%) Hearing Loss Conductive 72 (72%) Mixed 16 (16%) None 12 (12%) Mean Hearing Loss Pure tone average (dB) 32.5 ± 8.2 Table 3. Complications Observed in CSOM Patients (n = 100) Complication Number of Cases Percentage (%) Mastoiditis 9 9% Facial nerve palsy 5 5% Labyrinthitis 3 3% Intracranial abscess 3 3% Meningitis 2 2% Total 22 22%

In the present study involving 100 patients with chronic suppurative otitis media (CSOM), the highest incidence was noted in the 11–30 year age group, with a mean age of 27.4 years. This age distribution reflects the increased vulnerability of young adults, a pattern also observed in South Asian studies where environmental and socioeconomic factors play an important role in disease persistence [6,7]. A slight male predominance (58%) was observed, consistent with findings reported from Indian and Bangladeshi cohorts, although gender differences are not universally considered clinically significant [7,8]. Ear discharge was the universal symptom in our series, followed by hearing loss in 88% of patients. Similar clinical presentations have been described in large institutional reviews, where otorrhea and conductive hearing loss form the cornerstone of CSOM diagnosis [6,9]. The predominance of conductive hearing loss (72%) in our patients aligns with existing evidence that tympanic membrane perforation and ossicular chain involvement are the primary mechanisms of auditory deficit [6,10]. With respect to disease types, the tubotympanic form (68%) was more common than the atticoantral variety (32%). This pattern agrees with epidemiological studies from both India and neighboring countries, which consistently highlight the tubotympanic type as the most frequent presentation, though the atticoantral type carries higher risk due to cholesteatoma and potential for serious complications [7,9,11]. Complications were observed in 22% of cases, with mastoiditis being the most common (9%), followed by facial nerve palsy, labyrinthitis, and intracranial abscess. These findings are in line with institutional experiences, where extracranial complications continue to be more prevalent than intracranial ones, but the latter remain clinically significant due to their high morbidity and mortality [6,8]. A multicenter Nepalese study also highlighted the persistence of severe intracranial sequelae such as brain abscess and meningitis in inadequately managed CSOM [8]. The occurrence of such complications in our cohort underscores that despite the availability of antibiotics and surgical options, delays in diagnosis and treatment remain critical challenges. Antibiotic resistance has been identified as a growing concern in the management of CSOM. Recent bacteriological studies from India, Bangladesh, and China have documented a changing microbial spectrum and increasing resistance to commonly used agents [7,10,11]. This trend highlights the importance of regular microbial surveillance and rational antibiotic use to prevent therapeutic failures. Furthermore, non-clinical factors such as delayed healthcare-seeking behavior, as reported in a Rwandan study, continue to perpetuate complications and advanced disease at presentation [12]. Overall, our findings reinforce that CSOM remains a preventable cause of hearing loss and morbidity in resource-limited settings. Early identification, improved public awareness, timely medical therapy, and surgical intervention are crucial to minimize complications. Strengthening community-level healthcare delivery and addressing barriers to early care-seeking are equally vital in reducing the long-term burden of CSOM.

Chronic suppurative otitis media continues to be a significant health problem in developing regions, predominantly affecting young adults and leading to persistent ear discharge and hearing loss. The tubotympanic type remains more frequent, but the atticoantral variety carries greater risk due to its association with complications. In the present study, mastoiditis was the most common complication, followed by facial nerve palsy and intracranial sequelae, underscoring the morbidity of neglected disease. Despite advances in diagnostic and surgical techniques, preventable complications persist, emphasizing the need for early detection, patient awareness, and timely intervention. Strengthened community health initiatives are crucial for reducing the burden.

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