Background Context: Chronic Suppurative Otitis Media (CSOM) is a common cause
of hearing impairment and disability. CSOM caused by Pseudomonas aeruginosa is usually
treated with topical ciprofloxacin and resistance to ciprofloxacin in CSOM isolates has rarely been
Methods: A 24-year-old male patient with CSOM due to p. aeruginosa was reported. CSOM was
prolonged for ten years and physician prescribed topical ciprofloxacin drops, pus suctioning and
ear pH alteration. The treatment wasn’t effective and the patient came back to the clinic with relapse
of suppurative otitis media. P. aeruginosa was isolated as the cause of CSOM and the isolate
was resistant to ciprofloxacin, aztreonam, imipenem, gentamicin, doripenem, cefepime, levofloxacin,
amikacin and susceptible to colistin and ceftazidime. There were two mutations in gyrA and
eight mutations were observed in nfxB genes. Finally, tympanomastoidectomy was done.
Conclusion: Usually topical antibiotics, especially ciprofloxacin, is effective against ear infections
but our case was different and the P. aeruginosa isolated from CSOM was resistant to most
of the antibiotics. One reason for CSOM recurrence might be surgery failure. The routine and primary
treatment for CSOM did not seem sufficient and tympanomastoidectomy is suggested to be
the best treatment approach for these patients.