CSOM can be insidious, persistent, and very often destructive, with sometimes irreversible sequelae, such as hearing deficit and subsequent learning disabilities in children. In many patients with CSOM, a cholesteatoma may develop; a cholesteatoma is a pocket of skin that invades the middle ear and mastoid spaces from the edge of a perforation (43).
CSOM and cholesteatoma tend to be persistent and progressive and very often cause destructive irreversible changes in the bony structure of the ear. In many cases, the perforation of the tympanic membrane that occurs during AOM persists into the chronic stage.
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