DEFINITION CSOM is a long standing infection of apart or whole of middle ear cleftcharacterised by ear discharge andpermanent perforation.
EPIDEMIOLOGYHigher in developing countries - poor socioeconomic standards - poor nutrition - lack of health educationAffects both sexesAll age groups
TYPES Tubotympanic AtticoantralDischarge Profuse, mucoid, Scanty, Purulent, odourless foul smellingPerforation Central Attic or MarginalPolyp Pale Red and fleshyCholesteatoma Absent PresentGranulations Uncommon CommonComplications Rare CommonAudiogram Mild CD CD or Mixed
TUBOTYMPANICAetiologySequela of acute otitis mediaAscending infections via eustachian tube from infected tonsils, adenoids, infected sinusesAllergy to ingestants such as milk, egg,fish etc.
PATHOLOGICAL CHANGES1. Perforation of Pars tensa central perforation2. Middle ear mucosa inactive – normal active – oedematous and velvety
3. Polyp smooth mass of oedematous and inflammed mucosa ; pale4. Ossicular chain intact and mobile necrosis of long process of incus
5. Tympanosclerosis hyalinisation and calcification of subepithelial conn. tissue. white chalky deposits on ossicles, promontory, joints, tendons, ov al window and round window.6. Fibrosis and adhesions due to healing process
BACTERIOLOGYAerobic Ps. aeruginosa Proteus E coli Staph aureusAnaerobic Bact. fragilis Anaerobic streptococci
CLINICAL FEATURES1. Ear discharge Non offensive, mucoid or mucopurulent. Constant or intermittent.2. Perforation Central - anterior, posterior or inferior to handle of malleus. Small, medium or large.
3. Hearing loss Conductive Round window shielding effect Hears better in the presence of discharge than dry ear. Long standing cases – mixed type4. Middle ear mucosa Pale pink and moist – normal Red oedematous and swollen - inflammed
INVESTIGATIONS1. Examination under microscope Granulations Status of ossicular chain Ingrowth of sq epithelium from edges of perforation Tympanosclerosis Adhesions
2. Audiogram Conductive hearing loss3. Culture and sensitivity of ear discharge Select proper antibiotic ear drops4. Mastoid X-rays Usually sclerotic but may be pneumatised with clouding of air cells No bone destruction
TREATMENTto control infectioneliminate ear dischargecorrect hearing loss
1. Aural toilet - remove discharge and debris from ear dry mopping with absorbent cotton buds suction clearance under microscope irrigation with sterile NS