Topical antibiotics, the most common treatment for CSOM, act to kill or inhibit the growth of micro‐organisms that may be responsible for the infection. They can be used alone or in addition to other treatments for CSOM, such as antiseptics or ear cleaning (aural toileting). They can be applied directly to the ear as drops, ointments, sprays, or creams, potentially delivering high concentrations of antibiotic to the affected area. This review assesses the effects of topical antibiotics (without steroids) for people with CSOM. Associated Cochrane Clinical Answer: What are the benefits and harms of topical antibiotics for people with chronic suppurative otitis media?

Topical steroids are added to some topical antibiotic preparations, usually in the form of ear drops. It is thought that the addition of topical steroids to topical antibiotics could reduce the degree of inflammation in the outer or middle ear, which might also improve penetration of the antibiotic agent and reduce allergic sensitivity to the antibiotic component of ear drops. Although topical antibiotics are widely recommended as the first-line treatment for CSOM there are variations in practice and opinions as to whether preparations with additional topical steroids should be used. This review assesses the effects of topical antibiotics with steroids for people with CSOM. Associated Cochrane Clinical Answer: For people with chronic suppurative otitis media treated topically, how does an antibiotic (quinolone or non‐quinolone) plus steroid compare with a quinolone alone?

 Topical antiseptics are substances that kill or inhibit the growth and development of micro-organisms. Agents that have been used for treating CSOM include povidone-iodine, aluminium acetate, boric acid, chlorhexidine, alcohol, acetic acid, and hydrogen peroxide. Antiseptics or their application can cause irritation of the skin of the outer ear, manifesting as discomfort, pain, or itching. Some antiseptics may have the potential to be toxic to the inner ear, with a possible increased risk of causing sensorineural hearing loss, dizziness, or tinnitus. This review assesses the effects of topical antiseptics for people with CSOM. Associated Cochrane Clinical Answer: What are the benefits and harms of topical antiseptics for people with chronic suppurative otitis media? 

Antibiotics and antiseptics kill or inhibit the micro‐organisms that may be responsible for CSOM infection. Antibiotics can be applied topically or administered systemically via the oral or injection route. Antiseptics are always directly applied to the ear (topically). This review compares the effects of antibiotics versus topical antiseptics for people with CSOM. Associated Cochrane Clinical Answer: How do topical or combined topical/systemic antibiotics compare with topical antiseptics for people with chronic suppurative otitis media?

Antibiotics may be administered systemically, either by mouth, by injection into a vein (intravenous) or by injection into muscles (intramuscular). Although topical antibiotics are widely recommended as the first-line treatment for CSOM, systemic antibiotics are still used in situations where the delivery of drops to the middle ear is difficult. These include the treatment of young children and people with small perforations and/or copious ear discharge. Some antibiotics may be unsuitable for formulation as a topical ear drop so systemic antibiotics remain a viable option for the delivery of broad-spectrum antibiotics. Systemic antibiotics can have off-target side effects, such as diarrhoea or nausea, and also carry a risk of systemic allergic reactions such as a skin rash. This review assesses the effects of systemic antibiotics for people with CSOM. Associated Cochrane Clinical Answer: For people with chronic suppurative otitis media, what are the effects of systemic antibiotics?

The predominant symptoms of CSOM are ear discharge and hearing loss. Antibiotics are the most common treatment for CSOM, which act to kill or inhibit the growth of micro‐organisms that may be responsible for the infection. Antibiotics can be administered both topically and systemically, and can be used alone or in addition to other treatments for CSOM such as ear cleaning (aural toileting). This review compares the effects of antibiotics delivered topically (drops, ointments, sprays or creams) versus systemically (by mouth, intravenous or intramuscular) for people with CSOM. Associated Cochrane Clinical Answer: For people with chronic suppurative otitis media, how does a topical quinolone compare with a systemic antibiotic?

Aural toilet is an umbrella term describing a number of processes for manually cleaning the ear. Techniques used may include dry mopping (with cotton wool or tissue paper), suction clearance (typically under a microscope), or irrigation (using manual or automated syringing). Dry mopping may be effective in removing mucopurulent discharge. Compared to irrigation or microsuction it is less effective in removing epithelial debris or thick pus. Aural toileting can be used alone or in addition to other treatments for CSOM, such as antibiotics or topical antiseptics, to manually clean the ear canal, however, there have been reports of pain, bleeding and dizziness and/or vertigo with aural toileting. This review assesses the effects of aural toilet procedures for people with CSOM. Associated Cochrane Clinical Answer: For children with chronic suppurative otitis media, what are the effects of aural toileting?