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    03.chronic Supp Otitis Media

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    Jumanne Jay
    1. Chronic suppurative otitis media (CSOM) is an inflammatory condition of the middle ear associated with a tympanic membrane perforation lasting more than 3 months. 2. There are two main types: tubo-tympanic CSOM which is the most common, and atticoantral CSOM which is more severe and associated with cholesteatoma formation. 3. Complications can be extracranial like mastoiditis or intracranial like brain abscess. Treatment involves surgery to control infection as well as antibiotics.

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    03.chronic Supp Otitis Media

    Uploaded by

    Jumanne Jay
    130 views33 pages
    1. Chronic suppurative otitis media (CSOM) is an inflammatory condition of the middle ear associated with a tympanic membrane perforation lasting more than 3 months. 2. There are two main types: tubo-tympanic CSOM which is the most common, and atticoantral CSOM which is more severe and associated with cholesteatoma formation. 3. Complications can be extracranial like mastoiditis or intracranial like brain abscess. Treatment involves surgery to control infection as well as antibiotics.

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    03.CHRONIC SUPP OTITIS MEDIA

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    1. Chronic suppurative otitis media (CSOM) is an inflammatory condition of the middle ear associated with a tympanic membrane perforation lasting more than 3 months. 2. There are two main types: tubo-tympanic CSOM which is the most common, and atticoantral CSOM which is more severe and associated with cholesteatoma formation. 3. Complications can be extracranial like mastoiditis or intracranial like brain abscess. Treatment involves surgery to control infection as well as antibiotics.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    130 views33 pages

    03.chronic Supp Otitis Media

    Uploaded by

    Jumanne Jay
    1. Chronic suppurative otitis media (CSOM) is an inflammatory condition of the middle ear associated with a tympanic membrane perforation lasting more than 3 months. 2. There are two main types: tubo-tympanic CSOM which is the most common, and atticoantral CSOM which is more severe and associated with cholesteatoma formation. 3. Complications can be extracranial like mastoiditis or intracranial like brain abscess. Treatment involves surgery to control infection as well as antibiotics.

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    Chronic suppurative otitis

    media(CSOM)

    DR BUKANU
    ENT SPECIALIST
    DODOMA REFFERAL HOSPITAL
    Definition
    • Inflammatory condition of the
    mucoperiosteum of the middle ear cleft of
    more than three months duration and
    associated with tympanic membrane
    perforation
    types of chronic suppurative otitis
    media
    A) Tubo-tympanic SOM-commonest type,
    abt 99% of patients
    B) Attico antro SOM-more in temperate ares
    and mainly due to weather
    Tubo-tympanic CSOM
    • Characterized by chronic inflammation of
    mucoperiosteum and anterior tympanic
    membrane perforation
    • Wet type is associated with pus
    • It is usually a sequela of AOM
    Predisposing factors

    • Virulence of bacteria in AOM


    • Low host resistance
    • Inadequate treatment of AOM
    • Susceptibility of bacteria to chemotherapy
    Route of entry of bacteria
    • Ascending from the nasopharynx via the
    eustachian tube(about 90%)
    • Through a tympanic membrane perforation
    • Through hematogenous way due to
    bacteremia
    Pathology
    A) Thickened, edematous occasionally
    polypoid mucosa
    B) Granulation tissue which is a composite of
    C) Drum perforation
    D) Osteotis and ossicular necrosis
    E) Mucopurulent discharge-goblet cells that
    produce mucus increase in amount and
    inflammation
    Bacteriology
    1. Pseudomonas aureginosa-commonest
    bacteria
    2. Proteus vulgaris
    3. Staphylococcus aureus
    4. Klebsiella pneumonia
    5. Anaerobic bacteria eg bacteroides-
    Bacteroides melonogenicus
    6. Mycobacterium tuberculosis
    Investigations
    • Culture and sensitivity of the pus
    • Full Blood Picture
    • Audiometry-to find out whether the ear
    drum has been severely or moderately
    damaged
    • X-ray of the mastoid because the mastoid
    will be sclerosed
    • CT scan of the temporal bone
    Clinical presentation
    • Hearing loss
    • Pain but not a feature of CSOM but due to
    complication
    • Ear discharge (otorhea-discharge of pus
    from the ear)
    • Tinnitus
    • Dizziness which is associated with motion
    hallucinations(vertigo)
    Treatment
    1. Aural toilet-cleaning of the ear by using a
    cotton bud or sunction machine
    2. Local antibiotic therapy in form of ear drops,
    ciproflaxin ear drop
    3. Systemic antibiotics
    4. Mastoidectomy
    5. Tympanoplasty-operation done to the
    middle ear to repair the tympanic membrane
    and ossicular chain
    6. Adenotonsillectomy
    Atico antro CSOM
    • This is the presence of chronic otitis media
    with cholesteatoma in the middle ear
    • More severe because it is associated with
    a mass which produce collagen.
    Cholesteatoma
    • This is the presence of keratinizing
    squamous epithelium in an ectopic site(.eg
    middle ear or brain)
    Site
    • Attico antro COM occurs in the
    epitympanum (attic) and mastoid antrum
    Etiology
    • Congenital theory-due to reminant of cells left
    behind
    • Metaplasia theory-due to irritation of
    columnar epithelium to squamous epithelium
    • Migration theory-migration of cells from the
    external ear to the middle ear due to
    perforation
    • Retraction pocket theory-about 90% of
    cholesteatoma enters through this mean
    Congenital type
    • Download from the internet
    Metaplasia
    • Middle ear columnar
    A large cholesteatoma
    • Download a pic from the internet
    Clinical features
    1. Otorrhea: thick foul discharge with white
    blotting paper like material (cholesteatoma)
    2. Blood perforation
    3. Hearing loss: may be mild or severe
    4. Ear ache: occur if there associated otitis
    externa
    5. Bleeding: may occur if associated with
    granulation tissue is traumatized
    6. Vertigo: occurs if the horizontal
    7. Headache: this sx suggests pending
    intracranial complications
    Investigation
    • Culture and sensitivity
    • CT scan
    • Audiometry
    • FBP
    CT scan
    • CT scanning is the imaging modality of
    choice
    • Adv
    • Can detect subtke bony defects eg
    labyrynth fistula and ossicular involvement
    • MRI
    Rx
    • This diseases is more often associated with
    complications than tubo tympanic CSOM
    • Rx is surgical unless there are contra
    indications to surgery
    • Aim of the surgery is to have
    – an ear free of cholesteatoma
    – Create a safe ear
    – Hearing improvemnent
    Types of surgery
    • Mastoidestomy: opening into the mastoid
    antrum
    • Tympanoplasty
    Complications of SOM
    • Extracranial complications
    • Intracranial complications
    • Complication occur when the infection
    spread beyond the mucoperiosteum of the
    middle ear cavity
    Predisposing factors
    • Poor host immunity
    • Inadequate treatment
    Extracranial complications
    • Mastoiditis
    • Facial nerve palsy
    • Labyrinthitis
    • Petroritis
    Mastoiditis
    • Mastoiditis-destruction of the mastoid air
    cells by inflammatory exudate under
    pressure occurs.
    – a sub periosteal abscess may occur(post
    auricula abscess)
    – Pus from the mastoid may extend along the
    sternomastiod muscle forming an abscess
    Petroritis
    • Petroritis-this is the inflammation of the
    petrous pyramoid, such inflammation may
    involve adjacent structures i.e the
    trigeminal nerve ganglion and the abducent
    nerve leading to a triad syndrome i.e
    – Otorhea
    – Diplopia
    – Facial pain
    Facial nerve paralysis
    • Occurs when there is an infection
    extending into the fallopian canal through
    the bone erosion
    Labyrinthitis
    • Serous type: hyperemia of the labyrinth
    • Suppurative type: infection has directly
    entered labyrinth fluid causing pus
    • Clinical feature
    • Hearing loss
    • Vertigo
    • Tinnitus and horizontal nystagmus
    Intracranial complications
    • Extradural abscess
    • Subdural abscess
    • Brain abscess
    • The above will present with:
    – Headache, otorrhea, fever, vomiting and
    papiloedema
    – Impairment of consciousness
    – Convulsions and other neurologic signs
    Complications CT
    • Otic meningitis-most common
    complication
    • Lateral sinus thrombophlebitis-ususlly follo
    chronic mastoididtis
    • Otitic hydrocephalus-may follow due to
    destruction of the ventricles
    Management of the
    complications
    a. This depends on the type of complication,
    however mastoidectomy is indicated to
    control the aural infection
    b. A neurosurgeon is involved to handle the
    intracranial complications
    c. Drug therapy must take into account gram
    negative bacillus and anaerobic bacteria(3rd
    generation cephalosporin, ciproflacin

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