Most children who have chronic
suppurative otitis media require: (1) a thorough examination of the external canal and tympanic membrane with the otomicroscope (under
general anesthesia, if necessary); (2) a Gram
stain and culture obtained directly from the middle ear; (3) thorough aspiration of the ear canal and, if possible, the middle ear, i.e. "aural
toilet"; (4) treatment with an orally administered
antimicrobial agent and an ototopical medication, if the organisms are susceptible; and if the suppurative process is unresponsive to this management, hospitalization and the parenteral administration of an
antimicrobial agent. Parenteral antimicrobial
therapy should be selected following microbiologic assessment of the discharge. If the
infection can be eliminated using the methods described above, prevention of recurrence can be achieved by the following options: (1) prophylactic antimicrobial
therapy; (2) removal of the
tympanostomy tube; or (3) surgical repair of the tympanic membrane defect. The choice of these options depends on the age of the child and the status of the function of the eustachian tube. Middle ear and mastoid surgery should be reserved for those children who fail to respond to intensive medical
therapy.