This document discusses chronic otitis media (COM), a long-standing middle ear infection characterized by persistent ear discharge through a perforated eardrum. It defines the two main types - tubotympanic and atticoantral disease - and describes their signs, symptoms, causes, investigations, and treatment options including medical management and surgical procedures like myringoplasty, tympanoplasty, and ossiculoplasty. COM is more common in developing nations and usually starts in childhood, affecting hearing if left untreated. Accurate diagnosis involves examination, tests like audiograms and CT scans, and ruling out complications.
Chronic Suppurative Otitis Media: Tubotympanic Type (CSOM TT)Dr Krishna Koirala
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Stay informed, stay safe, and get your flu shot today!
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June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. DEFINITION OF COM
• Chronic otitis media is a
long standing infection
of a part or whole of the
middle ear cleft
characterised by
continuous or
intermittent
discharge through a
persistent
tympanic membrane
perforation.
3. EPIDEMIOLOGY
• Incidence is higher in developing countries
• Predisposing factors: Poor socio-economic
status, poor nutrition, lack of health education
• Affects both sexes
• All age groups
4. TYPES OF COM
Safe Type Or
Tubo Tympanic
Disease
Unsafe Type Or
Attico Antral
Disease
Active
(Mucosal /
Squamous)
Inactive
(Mucosal /
Squamous )
Healed
6. property Tubotympanic Atticoantral
Discharge Profuse,mucoid,
odourless
Scanty,purulent, foul smelling
Perforation Central Marginal
Granulations Uncommon Common
Polyp Pale Red and fleshy
Cholesteatoma Absent Present
Complications Rare Common
Audiogram Mild to moderate
conductive deafness
Conductive or mixed deafness
7. Tubotympanic Atticoantral
Mucosal disease with no evidence of
invasion of squamous epi.
Squamous disease of middle ear
Active-perforation of pars tensa with
inflammation of mucosa and
mucopurulent discharge
Active-presence of cholesteatoma in
posterosuperior part of pars tensa/in
pars flaccida. Erodes bone ,form
granulation tissue,has purulent
offensive discharge
Inactive- permanent perforation of
pars tensa but middle ear mucosa
isn’t inflamed & there’s no discharge.
Inactive-retraction in pars tensa/pars
flaccida,no discharge
Healed-tm is healed (by 2 layers)is
atrophic,easily retracted if –ve
pressure in middle ear
8. TUBOTYMPANIC DISEASE
( MUCOSAL TYPE)
• Disease confined to eustachian tube , anterior
and inferior part of mesotympanum and
hypotympanum
• Usually starts in childhood , so safe type is
common in that age group
• Presents with central perforation
• No underlying osteitis or osteomyelitis
9. AETIOLOGY
• Sequelae of acute otitis media
• Ascending infections via the
eustachian tube
• Nasal Allergy
• GERD
• Cranio facial abnormalities
• Autoimmune disease
13. TYPES OF PERFORATION
CENTRAL
PERFORATION:
• Perforation in the pars tensa
sorrounded all around by
pars tensa
MARGINAL
PERFORATION:
• Perforation in the pars tensa
surrounded partly by pars
tensa and partly by bone
14.
15. STAGES FEATURES
ACTIVE STAGE Discharging at the time of
examination.
QUIESCENT STAGE In the recent past, discharge
present but there is no discharge
now.
INACTIVE STAGE No discharge for 3- 6 months.
Dry ear.
HEALED STAGE TM Perforation has healed.
Permanently controlled middle ear
infection.
16. ATTICO ANTRAL DISEASE
• Chronic inflammatory condition of the
middle ear cleft confined to posterior part of
the mesotympanum , attic and antrum
associated with bone eroding disease or
cholesteatoma charactersied by thick,
purulent, scanty, foul smelling, blood stained
persistent discharge and may be associated
with perforation in pars flaccida
17.
18. CHOLESTEATOMA
• It is a cystic bag like structure lined by stratified
squamous epithelium containing desquamated
epithelial debris lying on a fibrous tissue stroma
of variable thickness
• Skin in the wrong place
• Synonym: keratoma, epidermosis
19.
20. THEORIES OF CHOLESTEATOMA
FORMATION
1. Congenital cell rests
2.Invagination theory:
(Wittmack)
• Invagination of TM from
attic or posterosuperior
part of pars tensa
22. 4. Basal cell hyperplasia
theory:
• Infection or inflammation
• Basal membrane breaks
• Squamous epithelium
invade into sub epithelial
tissue in pars flaccida like
epithelial cones forming
microcholesteatoma
• This enlarges and
perforates secondarily
through the TM
23. 5. Squamous metaplasia theory:
• Cuboidal epithelium can undergo metaplasia
to sq.epithelium
• Middle ear cuboidal epithelium is pluripotent
can be stimulated by inflammation to become
keratinising sq.epithelium
25. COMMON SITES OF CHOLESTEATOMA
• Most common sites of origin of acquired
cholesteatomas are
1. Posterior epitympanum
2. Posterior mesotympanum
3. Anterior epitympanum
28. PARS TENSA CHOLESTEATOMA SIGNS
• Retraction Pockets
• Cholesteatoma Flakes
• Granulation Tissue
• Polyp
• Hearing Loss
29. INVESTIGATION
• Examination under microscope
• Pus for C/S
• Audiological Assessment
• X-ray both Mastoids
• CT Scan Temporal bone
• Basic Investigations
• X-ray PNS
• Diagnostic Nasal Endoscopy
• Eustachian Tube Function Tests
30. EXAMINATION UNDER MICROSCOPE
• To confirm Otoscopic findings
• Site & size of perforation
• Margin of perforation
• Appearance of Middle ear
• Presence of Polyp & granulation Tissue and its site
31. PURE TONE AUDIOGRAM
• Identifying the presence
or absence of auditory
functions
• Differentiating
conductive from
sensorineural hearing
loss
• Degree of hearing loss
32. X-RAY BOTH MASTOIDS
• Pneumatisation of
mastoid air cells
• Hazziness / clouding of
air cells
• Low lying tegmen or
anteriorly lying sinus
plate
33. BASIC INVESTIGATIONS
• Complete hemogram : Hb, TC, DC, BT, CT, ESR
• B. Sugar
• B. Urea, S. Creatinine
• Urine analysis
• ECG
• X-Ray Chest PA view
36. EUSTACHIAN TUBE FUNCTION TESTS
• Valsalva Test
• Politzer Test
• Catheterisation
• Toynbees test
• Tympanometry
• Radiological Test
37. MEDICAL TREATMENT
• Short term goals :
Elimination of infection
Control of otorrhoea
• Long term goals :-
Improvement of hearing
Eventual healing of TM
• Aural Toileting - Dry Mopping
Wet mopping
Suction irrigation under microscope
• Topical Antibiotics
• Systemic Antibiotics
38. CAUSES OF FAILURE OF MEDICAL
TREATMENT
• Poor drainage of inflammatory exudate from the middle ear
• Presence of persistent osteitis with mastoid granulation
• Virulent & resistant organisms
• Reinfection via Eustachian tube – adenoid, sinuses
• Allergy
• Mastoid reservoir
39. CHEMICAL CAUTERIZATION
(MEDICAL MYRINGOPLASTY)
• Trichloroacetic acid
• Principle : The epithelium covering the margin
of the perforation is destroyed and exposing the
fibroblasts
• Mild irritations induces hyperemia and secondary
fibroblast proliferations
• Used in dry small to medium perforations
• Several sittings may be necessary
40. • Medical Treatment For Cholesteatoma :-
• Topical antibiotics with aural toileting
• Suction clearance
• Application of silver nitrate to granulation
tissue
• Antimetabolite - 5 – fluorouracil
• Reduces the activity of squamous epithelium &
curtail the production of keratin debris
• Ventilation Tubes In Attic Retractions
41. SURGICAL PROCEDURES
MYRINGOPLASTY
• An operation performed to repair or reconstruct the TM
TYMPANOPLASTY
• An operation performed to eradicate disease in the
middle ear and to reconstruct the hearing mechanisms
with out mastoid surgery, with or without TM grafting.
OSSICULOPLASTY
• An operation performed to repair or reconstruct the
ossicular chain
42. MYRINGOPLASTY
• Prerequisites
▫ Dry ear
▫ Good cochlear reserve
▫ Normal ET function
▫ Predominantly conductive hearing loss
▫ No cholesteatoma
• Types
▫ Grafting techniques – onlay, underlay
43. TYMPANOPLASTY
• TYPE I :
-intact ossicular chain.
-sound protection for round window.
• TYPE II:
-slight defect of the ossicles.
-middle ear is of about normal size.
• TYPE III:
- malleus and incus are extremely eroded
- columella effect.
• TYPE IV:
- mobile stapes foot plate.
- sound pressure transformation is given
up.
• TYPE V:
- Fixed stapes foot plate.
- sound pressure through fenestration.