title: Chronic suppurative otitis media: a review.
abstract: OBJECTIVE
  Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide. Although microbial, immunological, and genetically determined factors, as well as Eustachian tube characteristics, are supposed to be involved in the pathogenesis of CSOM, many aspects of the pathogenesis of CSOM still need to be clarified. Optimal treatment strategy has not been established yet. The objective of this review is to present and evaluate the current state of knowledge of CSOM.
  
  
  METHODS
  Systematic narrative review.
  
  
  METHODS
  A PubMed search (1966-January 2005) was performed for studies on epidemiology, pathogenesis, clinical management, and complications of CSOM. All included articles were categorized according to level of evidence.
  
  
  RESULTS
  Five hundred and fifty papers were identified, of which 79 were found to be relevant for this review. The definition of CSOM was found to vary. CSOM is a multifactorial disease. Regarding management of CSOM, there is no consensus as to what the optimal management strategy should entail. No convincing evidence is available for most medical and surgical therapies. Topical quinolones have proven effective, but need further monitoring regarding adverse effects.
  
  
  CONCLUSIONS
  Important goals in research of CSOM should be achieving consensus about the definition of CSOM and gaining more in-depth knowledge of the pathogenesis of CSOM, especially the role of innate and adaptive immunity. There is also a need for further well-designed studies on the effectiveness of various management strategies for CSOM.
authors.affiliation: Department of Otorhinolaryngology (KE04.140.5), Wilhelmina Children's Hospital, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Verhoeff
authors.forename: Erwin L
authors.initials: EL
authors.lastname: van der Veen
authors.forename: Maroeska M
authors.initials: MM
authors.lastname: Rovers
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Sanders
authors.forename: Anne G M
authors.initials: AG
authors.lastname: Schilder
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005064:Eustachian Tube / Q000503:physiopathology; D006310:Hearing Aids / Q000145:classification; D006801:Humans; D008876:Middle Ear Ventilation; D010035:Otitis Media, Suppurative / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D012008:Recurrence; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents