Current concepts in the surgical management of chronic suppurative otitis media

Abstract

Introduction. Chronic suppurative otitis media represents a major public health concern in both children and adults, particularly in developing countries. The condition poses not only a medical challenge requiring complex clinical management but also a public health issue with significant socioeconomic implications and costs. Material and methods. A review of selected literature from the PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases was conducted. Articles published between 2000 and 2025 were selected using the following keywords: “chronic otitis media” and “chronic suppurative otitis media,” combined in various ways with the terms “surgical treatment,” “mastoidectomy,” “canal wall-down,” “canal wall-up,” “canal wall-intact,” “canal wall reconstruction,” “tympanoplasty,” and “ossiculoplasty” to maximize search efficiency. Based on the search criteria, 325 fulltext articles were initially identified. The final bibliography included 66 relevant sources considered representative of the published material related to the topic of this review article. Results. There are four traditional surgical procedures for the treatment of chronic suppurative otitis media: 1) simple (cortical) mastoidectomy, 2) radical mastoidectomy, 3) modified radical mastoidectomy, and 4) mastoidectomy with tympanoplasty. These surgical interventions can be classified into two categories: open cavity (canal wall-down – CWD) and closed cavity (canal wall-up – CWU) or canal wall-intact (CWI). The CWD technique is the most effective method for cholesteatoma eradication, as it allows a wide-angle view of the mastoid and middle ear structures. Currently, radical CWD mastoidectomy is rarely performed but may be indicated when complete excision of the cholesteatoma is not possible. To prevent complications associated with the mastoid cavity following CWD, surgeons may opt for CWU mastoidectomy or CWD mastoidectomy with mastoid cavity obliteration and reconstruction of the external auditory canal wall. Conclusions. The current concept of managing patients with chronic suppurative otitis media involves developing a personalized approach based on anatomical, biological, radiological, and social factors. The selection of the surgical technique should be tailored to each patient according to the location and extent of the cholesteatoma, defects of the posterior canal wall, associated lesions, presence of complications, degree of hearing loss, and the patient’s overall medical condition.