Clinical Features and Outcomes of Chronic Otitis Media Complications: A 20-Year Retrospective Study at a Tertiary Hospital

Abstract

Objective: Chronic otitis media (COM) is a major public health concern, particularly in developing countries. Although complications have decreased with modern antibiotics, they still cause significant morbidity and mortality. This study analyzed the clinical features, bacteriological profiles, and treatment outcomes of COM complications at a tertiary hospital over 20 years. Methods: We conducted a retrospective review of medical records from 55 patients with COM complications at Songklanagarind Hospital (a total of 4364 patients, 2004–2023). Complications were classified as intracranial or extracranial. Data included demographics, clinical presentations, bacteriology, and clinical outcomes. Results: The overall complication rate was 1.26%, with intracranial complications at 0.21% (9 patients) and extracranial complications at 1.05% (46 patients). Common symptoms included otorrhea (85.5%) and otalgia (61.8%). Extracranial complications primarily included facial nerve palsy (60.0%), skull base osteomyelitis (14.5%), and subperiosteal abscesses (12.7%). Intracranial complications included brain abscess (5.5%), subdural empyema (5.5%), and lateral sinus thrombosis (3.6%). The predominant pathogens were Pseudomonas aeruginosa, Staphylococcus aureus, and Proteus mirabilis; however, no resistant strains were detected. Intracranial complications showed higher mortality (11.1% vs. 2.2%) and morbidity (22.2% vs. 19.6%) rates than extracranial complications. Conclusion: Although COM complications remain uncommon, the substantial morbidity rates warrant early recognition and aggressive management. The absence of resistant strains suggests that the current empirical antibiotic protocols were effective in our setting.