2. TYPES
Tubo-tympanic disease (TTD)
• Mucosal disease
• More in the ET and tympanic
cavity
• Safe type
Attico-antral disease (AAD)
• Presence of skin in the middle
ear cleft (cholesteatoma)
• More in the attic/ mastoid
segment
• Dangerous type

3. SYMPTOMS
Ear discharge
• Onset as ASOM/ traumatic perforation
• Intermittent, mucoid or mucopurulent, usually non-foul
smelling and non-blood stained
• Increases with URTI/ entry of water into the ear
• Decreases with resolution of URTI/ medications
Hearing impairment
• Usually mild to moderate
• Non-progressive
• Paradoxical hearing……………….(Round window shielding)

4. STAGES
Active
– Discharging ear during
presentation
– Ear discharge occurred
within 3 months before
presentation
• Inactive
– Dry ear for >6 months

5. SIGNS
• Characteristic ear discharge in the
middle ear and external auditory
canal
• Central perforation
• Middle ear mucosa- pale/
congested/ edematous/ polypoidal/
aural polyp
• Tuning fork test: Conductive
deafness
• Foci of sepsis in nose/ sinus/
nasopharynx/ external ear/ etc.

6. TREATMENT
Objective of treatment
• Active stage: Make the ear dry
• Inactive stage: Reconstruct the
middle ear

7. ACTIVE STAGE- MAKE THE EAR DRY
• Treat the septic focus- rhinitis/ sinusitis/
adenoiditis/ external otitis/ etc..
• Aural toilet
• Antibiotics
Topical: Antibiotic with or without steroid till
ear is dry
• Nasal decongestants/ antihistamines/ steroid
nasal spray

8. TECHNIQUES:
Skin Mucosa
Overlay Underlay
Approaches: Post aural/ endaural/ endomeatal

9. Complications
• Tubo-tympanic disease is usually safe. ‘Patients can
defer surgery if ear is dry and aural hygiene can be
observed’
• TTD may give rise to following:
 Secondary acquired cholesteatoma
 Mixed deafness
 Tympanosclerosis
 Recurrent re-infection of the middle ear
• Hence prefer reconstructive surgery