Aim: This study aimed to investigate the epidemiology, clinical characteristics, treatment-seeking behavior, and pharmacological management of Chronic Suppurative Otitis Media (CSOM) among children in rural communities, with a focus on identifying barriers to effective treatment. Material and Methods: A community-based, cross-sectional study was conducted among 140 children aged 1–15 years diagnosed with CSOM in three selected rural communities. Participants were recruited using a multi-stage sampling technique. Data were collected through clinical examinations performed by a trained otolaryngologist and structured interviews with parents/guardians. Information on demographics, clinical history, pharmacological treatments, and barriers to healthcare access was gathered. Statistical analysis was performed using SPSS version 21.0, applying descriptive and inferential statistics to identify significant associations. Results: The highest prevalence of CSOM was observed among children aged 6–10 years (39.29%), with males (53.57%) more affected than females (46.43%) (p = 0.038). Hearing loss (50.00%) was the most common symptom, and unilateral infections (60.71%) were more frequent (p = 0.031). Antibiotics (71.43%) were the most common treatment modality, followed by analgesics (50.00%) and antiseptics (42.86%) (p = 0.033). Barriers to effective treatment included limited healthcare facilities (35.71%), high treatment costs (28.57%), and lack of awareness (21.43%) (p = 0.022). Conclusion: CSOM remains a significant health burden in rural communities, particularly among children aged 6–10 years and families with lower parental education levels. Hearing loss and prolonged ear discharge were predominant symptoms. Despite reliance on antibiotics, barriers such as healthcare inaccessibility, financial constraints, and lack of awareness hinder effective treatment. Addressing these challenges through improved healthcare infrastructure, targeted awareness programs, and affordable treatments is essential to reduce CSOM prevalence and complications.