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Chronic suppurative otitis media
 

Chronic suppurative otitis media

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    Chronic suppurative otitis media Chronic suppurative otitis media Presentation Transcript

    • CHRONIC SUPPURATIVE OTITIS MEDIA
    • Introduction
      • CSOM is a long-standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation.
    • Epidemiology
      • Higher in developing countries because of poor socioeconomic standards, poor nutrition and lack of health education.
      • Both sexes and all age groups.
    • TYPES
      • Tubotympanic or safe
      • Profuse, mucoid, odourless discharge
      • Central perforation
      • Granulations uncommon
      • Pale polyp
      • Cholesteatoma absent
      • Complications rare
      • Mild to moderate conductive deafness
      • Atticoantral or unsafe
      • Scanty, purulent, foul-smelling discharge
      • Attic or marginal perforation
      • Granulations common
      • Red and fleshy polyp
      • Cholesteatoma present
      • Complications common
      • Conductive or mixed deafness
    • Tubotympanic type
      • Aetiology
      • It is the sequelae of acute otitis media usually following exanthematous fever and leaving behind a large central perforation.
      • Ascending infections via the eustachian tube.
      • Persistent mucoid otorrhea is sometimes the result of allergy to ingestants such as milk, eggs, fish, etc.
    • Central perforation
    • Pathology
      • Perforation of pars tensa
      • Middle ear mucosa- normal when disease is quiscent or inactive. Oedematous and velvety when disease is active.
      • Polyp
      • Ossicular chain
      • Tympanosclerosis
      • Fibrosis and adhesions
    • Bacteriology
      • Pus culture in both types of aerobic and anaerobic CSOM may show multiple organisms.
      • Common aerobic organisms are Ps. Aeruginosa, Proteus, E. coli and Staph. Aureus, while anaerobes include Bacteroides fragilis and anaerobic Streptococci.
    • Alternative classification
      • Tubotympanic
      • Active- perforation of pars tensa, inflammation of mucosa and mucopurulent discharge.
      • Inactive- permanent perforation of pars tensa but middle ear mucosa is not inflamed and there is no discharge.
      • Atticoantral
      • Active- presence of cholesteatoma of posterosuperior region of pars tensa or in pars flaccida.
      • Inactive- retraction pockets in pars tensa or pars flaccida.
    • Clinical features
      • Ear discharge- non-offensive, mucoid or mucopurulent, constant or intermittent.
      • Hearing loss- conductive type
      • Round window phenomenon
      • Perforation
      • Middle ear mucosa- normally, it is pale pink and moist; when inflamed it looks red, oedematous and swollen.
    • Investigations
      • Examination under microscope
      • Audiogram
      • Culture and sensitivity of ear discharge
      • Mastoid X- rays/ CT scan temporal bone
    • Treatment
      • Aural toilet
      • Ear drops
      • Systemic antibiotics
      • Precautions
      • Treatment of contributory causes- tonsils, adenoids, maxillary antra and nasal allergy
      • Surgical treatment
      • Reconstructive surgery
    • Atticoantral type
      • Aetiology- cholesteatoma
      • Patology
      • Cholesteatoma
      • Osteitis and granulation tissue
      • Ossicular necrosis
      • Cholesterol granuloma
    • Cholesteatoma
    • Symptoms and signs
      • Symptoms
      • Ear discharge- usually scanty, but always foul smelling due to bone destruction
      • Hearing loss
      • Bleeding
      • Signs
      • Perforation
      • Retraction pocket
      • Cholesteatoma
    • Investigations
      • Examination under microscope
      • Tuning fork tests and audiogram
      • X- ray mastoids/ CT scan temporal bone
      • Culture and sensitivity of ear discharge
    • Features indicating complications of CSOM
      • Pain
      • Vertigo
      • Persistent headache
      • Facial weakness
      • A listless child refusing to take feeds and easily going to sleep
      • Fever, nausea and vomiting
      • Irritability and neck rigidity
      • Diplopia
      • Ataxia
      • Abscess around ear
    • Treatment
      • Surgical treatment
      • Canal wall down procedure
      • Canal wall up procedure
      • Reconstructive surgery
      • Conservative treatment
    • Comparison of procedures Problems in fitting a hearing aid due to large meatus and mastoid cavity which sometimes gets infected Easy to wear a hearing aid if needed Auditory rehabilitation Swimming can lead to infection of mastoid cavity and it is thus curtailed No limitation. Patient allowed swimming. Patients limitations Not required Requires second look surgery after 6 months or so to rule out cholesteatoma Second look surgery Low rate of recurrence or residual disease and thus a safe procedure High rate of recurrent or residual cholesteatoma Recurrence or residual disease Dependence on doctor for cleaning mastoid cavity once or twice a year Does not require routine cleaning Dependence Widely open meatus communicating with mastoid Normal appearance Meatus Canal wall down procedure Canal wall up procedure
    •