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
Case Presentation: 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
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.