Chronic suppurative otitis media (CSOM) is a significant global health problem, especially in countries with low and middle income, where the incidence of the disease is considerably higher. The review highlights the epidemiology, microbiological spectrum, and current therapeutic approaches to CSOM. The main pathogens include Pseudomonas aeruginosa and Staphylococcus aureus, including methicillin-resistant strains (MRSA), which complicate treatment due to biofilm formation and antibiotic resistance. Immunological factors, including cytokine imbalances, contribute to the chronicity and severity of the disease. A comprehensive approach that includes microbiological diagnostics, assessment of immune status, and individualized therapy can improve treatment outcomes and reduce the need for surgical interventions.

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