CSOM TUBO TYMPANIC DISEASE

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CSOM TUBO TYMPANIC DISEASE

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

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