What is the Difference Between ASOM and CSOM

ASOM and CSOM are two types of otitis media. ASOM stands for Acute suppurative otitis media, while CSOM stands for Chronic suppurative otitis media. Otitis media is a middle ear infection. Otitis media can be further categorized into different types based on clinical presentation, onset of symptoms, associated complications, and treatment, which include acute otitis media, otitis media with effusion, chronic suppurative otitis media, and adhesive otitis media.

The key difference between ASOM and CSOM is their cause. ASOM is a subtype of acute otitis media usually caused by bacteria such as  Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, while CSOM is a main type of otitis media usually caused by acute otitis media, blockage of the eustachian tube, an injury to the ear, chemical burns, or blast injuries.

CONTENTS

1. Overview and Key Difference
2. What is ASOM  
3. What is CSOM
4. Similarities – ASOM and CSOM
5. ASOM vs CSOM in Tabular Form
6. Summary – ASOM vs CSOM
7. FAQ – ASOM and CSOM

What is ASOM?

Acute suppurative otitis media (ASOM) is the most common infection in childhood. It is a subtype of acute otitis media. It is more common in children and infants. It is also common after upper respiratory infection and in winter and spring. ASOM is usually caused by bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The prominent signs and symptoms of this condition are severe deep ear pain, high fever,  conductive hearing loss in the affected ear, tinnitus, purulence in the middle ear, vomiting, and convulsions.

Acute suppurative otitis media can be diagnosed through physical examination, otoscopy, blood test, and X-rays. Furthermore, acute suppurative otitis media is treated through antibiotic therapy using antibiotics such as ampicillin and amoxicillin-clavulanate, and surgery to repair the tympanic membrane.

What is CSOM?

Chronic suppurative otitis media (CSOM) is a chronic middle ear mucosal inflammation. It is also characterized by perforation of the tympanic membrane and persistent or intermittent otorrhea, which persists for a minimum of 2-6 weeks. CSOM is classified into 2 main types: attico-antral and tubo-tympanic. Attico-antral involves the pars flacida of the tympanic membrane, while tubo-tympanic involves the pars tensa of the tympanic membrane.

The causes of chronic suppurative otitis media include acute otitis media, blockage of the eustachian tube, injury to the ear, chemical burns, or blast injuries. Moreover, the common presenting symptoms of this condition are hearing loss in the affected ear, fever, vertigo, pain, and otorrhea. The serious complications of CSOM are headache, nystagmus, labyrinthitis, facial paralysis, and swelling/tenderness behind the ear.

CSOM can be diagnosed through physical examination, audiogram, CT scan, and MRI. Furthermore, treatment options for CSOM may include keeping the affected ear dry,  micro suction of the exudate from the ear canal, using equipment to carry out aural cleaning, using topical antibiotics quinolones, aminoglycosides, and fluoroquinolones, using topical steroids to reduce granuloma formation, surgeries like radical mastoidectomy, modified radical mastoidectomy or a combined approach called tympanoplasty and cochlear implants.

Similarities Between ASOM and CSOM

1. ASOM and CSOM are two different middle ear infections.
2. Both types are characterized by similar features such as otorrhea, tympanic membrane perforations, etc.
3. Both types are common in children.
4. They can be diagnosed through physic examination and imaging tests.
5. They can be treated through antibiotic therapy and specific surgeries.

Difference Between ASOM and CSOM

Definition

1. ASOM is a subtype of acute otitis media otitis media.
2. CSOM is a main type of otitis media.

Cause

1. ASOM is usually caused by bacteria such as  Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
2. CSOM is usually caused by acute otitis media, blockage of the eustachian tube, an injury to the ear, chemical burns, or blast injuries.

Signs and Symptoms

1. Signs and symptoms of ASOM include marked earache, high fever, deafness, tinnitus, otorrhea for less than 3 weeks, vomiting convulsion, and tympanic membrane perforation.
2. Signs and symptoms of CSOM include hearing loss in the affected ear, fever, vertigo, pain, otorrhea for 2 to 6 weeks, and tympanic perforation.

Diagnosis

1. ASOM can be diagnosed by physical examination, otoscopy, blood test, and X-rays.
2. CSOM can be diagnosed by physical examination, audiogram, tympanometry, CT scan, and MRI.

Treatment

1. ASOM can be treated by taking broad-spectrum oral antibiotics and tympanoplasty for closure of TM perforation.
2. CSOM can be treated through aural toileting and taking topical antibiotics or steroid treatments and surgeries like myringoplasty and tympanoplasty.

The following table summarizes the difference between ASOM and CSOM.

Summary – ASOM vs CSOM

Otitis media is inflammation or infection in the middle ear. ASOM and CSOM are two different middle ear infections. ASOM is a subtype of acute otitis media. ASOM is characterized by pus accumulation in the middle ear and bulging and perforation of the tympanic membrane. On the other hand, CSOM is a main type of otitis media characterized by a persistent, chronically draining, suppurative perforation of the tympanic membrane. Furthermore, ASOM is triggered by infections by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, whereas CSOM is triggered by acute otitis media, blockage of the eustachian tube, an injury to the ear, chemical burns, or blast injuries. This is the summary of the difference between ASOM and CSOM.

FAQ: ASOM and CSOM

1. What causes acute suppurative otitis media?

• The usual pathogens that cause ASOM include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Acute suppurative otitis media also normally causes severe deep ear pain, fever, and conductive hearing loss in the affected ear.

2. How do you diagnose ASOM?

• ASOM is diagnosed clinically through objective findings on physical examination combined with the patient’s medical history and presenting signs and symptoms. Other available tests that help in the diagnosis of ASOM include pneumatic otoscope, tympanometry, and acoustic reflectometry.

3. What is the drug of choice for acute suppurative otitis media?

• ASOM is treated using high-dose amoxicillin (80 to 90 mg per kg per day). It is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin.

4. What are the symptoms of CSOM in the ear?

• Common presenting symptoms of CSOM are hearing loss in the affected ear, fever, vertigo, and pain. The complications include headache, nystagmus, labyrinthitis, facial paralysis, and swelling/tenderness behind the ear.

5. What is the best surgery for CSOM?

• Tympanoplasty is the surgery for CSOM that seals the perforation in the tympanic membrane. It prevents the translocation of bacteria from the external ear canal into the middle ear. The other treatment options include aural toileting and topical antibiotics (aminoglycosides and fluoroquinolones) or topical steroids.

Reference:

1.“Acute Suppurative Otitis Media – An Overview.” ScienceDirect Topics.
2. Rosario, Digna C. “Chronic Suppurative Otitis.” StatPearls, U.S. National Library of Medicine.

Image Courtesy:

1. “Acute Otitis Media Stage of Resolution” By Michael Hawke MD – Own work (CC BY 4.0) via Commons Wikimedia

2. “Otitis Media” By BruceBlaus – Own work (CC BY-SA 4.0) via Commons Wikimedia

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