Chronic Suppurative Otitis Media

1. Chronic Suppurative
Otitis Media (CSOM)
Atticoantral Type

2. Anatomy of Ear

3. Tympanic membrane seen by Otoscope.
Line diagram of tympanic membrane

5. Ossicles
• Malleus
• Incus
• Stapes

6. Introduction
• Chronic = > 6months
• Suppurative = pus formation
• Otitis Media = inflammation of middle ear
• Atticoantral = attic and mastoid antrum
• Also called as Squamous type.
• Pathology on Attic area or Posterosuperior
quadrant.
• Pathology is either Cholesteatoma or
granulation tissue.

7. Cholesteatoma
• Skin in the wrong place
• Not a tumour
• Has bone eroding properties
• Causes risk of serious complications.
• Also called unsafe or dangerous type.

8. Pathology
• Congenital
• Acquired
– Primary
– Secondary
– Tertiary

9. • Theories of cholesteatoma formation
– Invasion
– Negative middle ear pressure
– Metaplasia

10. Clinical Features
Symptoms:
• Ear discharge:
– continuous, scanty, yellowish, purulent, foul smelling,
blood stained.
• Hearing loss:
– CHL / SNHL
• Bleeding:
• Symptoms of complication:
– Pain, Vertigo, Deep seated Headache, Facial
weakness, Fever, Nausea/ Vomiting, Swelling around
ear, Deafness, Fainting.

11. Clinical Features
Signs:
• Perforation:
– Pars Flaccida,
– PS Quadrant of Pars Tensa
• Retraction Pocket:
• Cholesteatoma / granulation tissue:

12. Investigations
• Audiogram:
• X-ray Mostoids:
• C/S of ear discharge:

13. Treatment:
• At primary level:
– Explain about the disease process
– Advice for the aural precaution
– Antibiotic ear drops.
– In severe cases, oral antibiotics.
– Refer to ENT surgeon for definitive treatment.
• Surgery:
– Mastoid exploration (MRM)

14. THANX