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CSOM TUBO TYMPANIC DISEASE
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CSOM TUBO TYMPANIC DISEASE

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  • 1. CSOM - TUBOTYMPANIC
  • 2. DEFINITION CSOM is a long standing infection of apart or whole of middle ear cleftcharacterised by ear discharge andpermanent perforation.
  • 3. EPIDEMIOLOGYHigher in developing countries - poor socioeconomic standards - poor nutrition - lack of health educationAffects both sexesAll age groups
  • 4. 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
  • 5. TUBOTYMPANICAetiologySequela of acute otitis mediaAscending infections via eustachian tube from infected tonsils, adenoids, infected sinusesAllergy to ingestants such as milk, egg,fish etc.
  • 6. PATHOLOGICAL CHANGES1. Perforation of Pars tensa  central perforation2. Middle ear mucosa  inactive – normal  active – oedematous and velvety
  • 7. 3. Polyp  smooth mass of oedematous and inflammed mucosa ; pale4. Ossicular chain  intact and mobile  necrosis of long process of incus
  • 8. 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
  • 9. BACTERIOLOGYAerobic Ps. aeruginosa Proteus E coli Staph aureusAnaerobic Bact. fragilis Anaerobic streptococci
  • 10. 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.
  • 11. 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
  • 12. INVESTIGATIONS1. Examination under microscope  Granulations  Status of ossicular chain  Ingrowth of sq epithelium from edges of perforation  Tympanosclerosis  Adhesions
  • 13. 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
  • 14. TREATMENTto control infectioneliminate ear dischargecorrect hearing loss
  • 15. 1. Aural toilet - remove discharge and debris from ear  dry mopping with absorbent cotton buds  suction clearance under microscope  irrigation with sterile NS
  • 16. 2. Ear drops Neomycin, Polymyxin, Chloromycetin, Gentamycin  Steroids3. Systemic antibiotics a/c exacerbation of c/c infected ear
  • 17. 4. Precautions keep water out of ear hard nose blowing avoided5. Treatment of contributory cause infected tonsils, adenoids, nasal allergy
  • 18. 6. Surgical treatment aural polyps and granulations if present7. Reconstructive surgery myringoplasty

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