title: Chronic otitis media in children: an evidence-based guide for diagnosis and management.
abstract: OBJECTIVE
  To provide an easy-to-follow evidence-based diagnostic and therapeutic algorithm for the management of chronic otitis media (COM) in children.
  
  
  METHODS
  Literature review and critical analysis of the available evidence in Medline and other scientific database sources.
  
  
  RESULTS
  Otorrhea and hearing loss are the cardinal symptoms of COM, while oto-microscopy and imaging techniques can confirm the diagnosis. Conservative treatment is acceptable to some extent (i.e. mild cases of COM without cholesteatoma). It involves topical drops (quinolones as first choice drugs- strength of recommendation B), as well as performing aural toilet (strength of recommendation B), and avoiding water ingress. Tympanoplasty without mastoidectomy is expected to improve hearing in cases of non-cholesteatomatous COM (strength of recommendation C), and positively affect the children's quality of life (strength of recommendation B). Less experienced surgeons and inflamed, wet middle ear mucosa represent the two most important factors, which could lead to reperforations (strength of recommendation C). The surgical management of COM with cholesteatoma tends to employ the least invasive surgical technique, in order to obtain a small self-cleaning mastoid cavity, as well as good hearing results (strength of recommendation C).
  
  
  CONCLUSIONS
  The treatment of choice in most cases of pediatric COM is surgery. Figure 1 proposes a detailed and easy-to-follow evidence-based algorithm with regard to the diagnosis and management of COM in children.
authors.affiliation: Attikon University Hospital, Athens, Greece.
authors.forename: Nikolaos S
authors.initials: NS
authors.lastname: Tsilis
authors.forename: Petros V
authors.initials: PV
authors.lastname: Vlastarakos
authors.forename: Vassilios F
authors.initials: VF
authors.lastname: Chalkiadakis
authors.forename: Dimitrios S
authors.initials: DS
authors.lastname: Kotzampasakis
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Nikolopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D010033:Otitis Media / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015363:Quinolones / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones
keywords: children; cholesteatoma; chronic otitis media; ear; hearing loss; otorrhea; pediatric; tympanoplasty