This document discusses chronic suppurative otitis media (CSOM), specifically the tubotympanic type. It defines CSOM and describes the anatomy of the middle ear cleft. It discusses the epidemiology, types, etiology, clinical features, investigations and treatment of tubotympanic CSOM. Non-surgical treatment includes aural toilet, antibiotics, and antihistamines. Surgical treatments covered are myringoplasty to repair perforations, and tympanoplasty for more extensive middle ear reconstruction.
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otitis media is the inflammation of the ear drum or tympanic membrane this topic include its definition , etiology, pathophysiology, clinical manifestation, diagnosis and its treatment which can be used by nursing students for taking care of the patient suffering from otitis media and for learning for their examination and knowledge purpose
and care of the child with acute otitis media and chronic otitis media and make their family aware about the complication of the otitis media like hearing loss meningitis
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2. OBJECTIVES:
At the end of this class, you should be able
to describe:
•Lining epithelium of the middle ear cleft
•Definition of CSOM
•Types of CSOM and clinical features of
Tubotympanic disease(TTD)
•Types of perforation.
•Investigations for CSOM-TTD
•Treatment of CSOM-TTD
5. LINING EPITHELIUM OF MIDDLE EAR
CLEFT
•Antero inferiorly – ciliated columnar epithelium
•Posteriorly – cuboidal type
•Epitympanum and mastoid air cells – flat
nonciliated epithelium (pavement epithelium)
6. Definition
•Chronic suppurative 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.
7. 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
8. •In India overall prevalance rate is :
Rural: 46 per thousand
Urban : 16 per thousand
•CSOM is the single most important
cause of hearing impairment in rural
population.
9. TYPES OF CSOM
SafeType Or
TuboTympanic
Disease
UnsafeType Or
Attico Antral
Disease
Mucosal(active /
inactive)
Squamous
(active/inactive)
Healed
10. TUBOTYMPANIC DISEASE
•Disease confined to anteroinferior part of
middle ear cleft -eustachian tube
,mesotympanum .
• Presents with central perforation.
•No risk of serious complication
•Usually starts in childhood , so safe type
is common in that age group
•No underlying osteitis or osteomyelitis
13. Following exanthematous fever
acute otitis media
leaving behind a central perforation ,perforation
becomes permanent and permits repeated infection
from the external ear.
14. •Middle ear mucosa is exposed to the
environment and gets sensitized to dust ,pollen
and other aeroallergens causing persistent
otorrhoea.
15. 2 ) Via Eustachian tube
• Infection of tonsils, adenoids
,sinusitis, regurgitation of milk.
20. •Hearing Loss:
•Usually conductive (25-50 dB) but might
be normal in small, dry perforations.
•Round window shielding by ear
discharge leads to better hearing in acute
exacerbations.
21. ROUND WINDOW SHIELDING
EFFECT
•Patient hears better in the presence of
discharge rather than dry ear
• Effect is produced by discharge, by
maintaining phase differential
22. •In dry ear, sound waves strike both the Oval
and Round windows simultaneously, thus
cancelling each other’s effect with no
movement of perilymph, and thus, no
hearing.
26. LAYERS OFTYMPANIC MEMBRANE
• Outer epithelial layer : continuous with skin .
• Middle fibrous layer : which encloses the handle of
malleus and has three types of fibres –radial, circular and
parabolic.
• Inner mucosal layer :continuous with the mucosa of the
middle ear
32. •Subtotal perforation: perforation in pars tensa which
involves all 4 quadrants and is surrounded by
annulus tympanicus
•Annulus tympanicus: periphery of TM is thickened to
form a fibrocartilaginous ring
36. 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.
41. Precautions
•Encourage breast feeding with child’s
head raised. Avoid bottle feeding
•Avoid forceful nose blowing
•Plug E.A.C. with Vaseline smeared
cotton while bathing & avoid swimming
•Avoid putting oil , water or self-
cleaning of ear
42. • Done only for active stage
• Dry mopping with cotton swab
• Suction clearance: best method
• Gentle irrigation (wet mopping)
Aural Toilet
43. Antibiotics
• Topical Antibiotics:
• Ciprofloxacin, Gentamicin, Tobramycin
• Antibiotics + Steroid: for polyps, granulations
• Neosporin + Betamethasone /
Hydrocortisone
• Oral Antibiotics: for severe infections
45. 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
46. •Used in dry small to medium perforations
•Several sittings may be necessary
48. Surgical Treatment
•Indicated in inactive or quiescent stage
•Myringoplasty
•Tympanoplasty
•Indicated in active stage
•Cortical Mastoidectomy
•Aural polypectomy
50. Aims
• Permanently stop ear discharge : make the ear dry and safe
• Improve hearing if ossicles are intact and mobile and there is
absence of sensori-neural deafness
• Prevention of ongoing complications like further hearing loss,
tympanosclerosis, adhesions, mucosal bands, vertigo
• Wearing of hearing aid
• Occupational: military, pilots
• Recreation: swimming, diving
61. Why temporalis fascia?
•Basal metabolic rate lowest (best survival
rate)
•Easy to harvest
•Large size graft can be harvested
•Autograft, so no rejection
•Same thickness as normal tympanic
membrane
•Good resistance to infection
62. 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
68. Type Pathology Graft placed on
I Ear drum perforation only Malleus handle
II Malleus handle eroded Incus
III Malleus + Incus eroded Stapes head
IV Only footplate remains: mobile Footplate exposed
V Only stapes remains: fixed Lateral SCC
opening
VI Only footplate remains: mobile Round window
exposed (Sono
inversion )
