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    CSOM

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    Sunil Kumar
    This document discusses different types of chronic otitis media, including chronic non-suppurative otitis media such as otitis media with effusion, and chronic suppurative otitis media which can be tubotympanic or atticoantral. Tubotympanic chronic suppurative otitis media presents with intermittent discharge and central perforation, and is treated conservatively or with tympanoplasty. Atticoantral chronic suppurative otitis media often involves cholesteatoma, presenting with persistent discharge, attic or marginal perforation, and is treated with mastoidectomy to remove the cholesteatoma and provide a dry ear.

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    CSOM

    Uploaded by

    Sunil Kumar
    484 views74 pages
    This document discusses different types of chronic otitis media, including chronic non-suppurative otitis media such as otitis media with effusion, and chronic suppurative otitis media which can be tubotympanic or atticoantral. Tubotympanic chronic suppurative otitis media presents with intermittent discharge and central perforation, and is treated conservatively or with tympanoplasty. Atticoantral chronic suppurative otitis media often involves cholesteatoma, presenting with persistent discharge, attic or marginal perforation, and is treated with mastoidectomy to remove the cholesteatoma and provide a dry ear.

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    This document discusses different types of chronic otitis media, including chronic non-suppurative otitis media such as otitis media with effusion, and chronic suppurative otitis media which can be tubotympanic or atticoantral. Tubotympanic chronic suppurative otitis media presents with intermittent discharge and central perforation, and is treated conservatively or with tympanoplasty. Atticoantral chronic suppurative otitis media often involves cholesteatoma, presenting with persistent discharge, attic or marginal perforation, and is treated with mastoidectomy to remove the cholesteatoma and provide a dry ear.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    484 views74 pages

    CSOM

    Uploaded by

    Sunil Kumar
    This document discusses different types of chronic otitis media, including chronic non-suppurative otitis media such as otitis media with effusion, and chronic suppurative otitis media which can be tubotympanic or atticoantral. Tubotympanic chronic suppurative otitis media presents with intermittent discharge and central perforation, and is treated conservatively or with tympanoplasty. Atticoantral chronic suppurative otitis media often involves cholesteatoma, presenting with persistent discharge, attic or marginal perforation, and is treated with mastoidectomy to remove the cholesteatoma and provide a dry ear.

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    Download as ppt, pdf, or txt
    of 74

    CHRONIC OTITIS MEDIA

    Classification of Chronic Otitis Media


    Chronic Non Suppurative Otitis Media
    Otitis media with effusion OME Adhesive otitis media

    Chronic Suppurative Otitis Media CSOM


    Tubotympanic (Safe) Atticoantral (Unsafe)

    OTITIS MEDIA WITH EFFUSION

    DEFINITION
    Presence of non-purulent fluid within the middle ear cleft

    SYNONYMS
    Secretory otitis media Middle ear effusion Sero-mucinous otitis media Catarrhal otitis media Glue ear Serous otitis media Non-suppurative otitis media

    PREVALENCE
    Between 20% and 50% of children do have OME at some time between 3 and 10 years of age Two peaks at 2 and 5 years of age

    RISK FACTORS
    Race Age Gender Season Nasopharyngeal anatomical abnormalities Cleft palate Smoking ? Allergy

    HISTOPATHOLOGY
    Changes in the mucosa
    Vasodilatation & mononuclear cell infiltration Metaplasia of the epithelium to ciliated columnar Mucus secreting gland formation

    Formation of fluid in the middle ear


    Transudate Exudate Secretion

    ETIOPATHOLOGY
    Eustachian tube dysfunction

    Chronic inflammation

    ETIOLOGY
    Eustachian tube dysfunction
    Poor muscular function Adenoids Barotrauma Others

    Infections
    Unresolved AOM Adenoiditis and other URTIs

    SYMPTOMS
    Hearing impairment Otalgia Fluid sensation

    Diagnosis

    DIAGNOSIS

    DIAGNOSIS
    Otoscopy Tuning fork tests

    DIAGNOSIS
    Otoscopy Tuning fork tests PTA

    DIAGNOSIS
    Otoscopy Tuning fork tests PTA Tympanometry

    DIAGNOSIS
    Otoscopy Tuning fork tests PTA Tympanometry Myringotomy

    TREATMENT
    Treatment of the cause if feasible Observation Medical treatment
    Antibiotics Decongestants, ?Auto-inflation ?Steroids

    Surgical
    Myringotomy Ventilation tubes (grommets)

    COMPLICATIONS OF VENTILATION TUBES INSERTION


    Infection Blockage Extrusion Tympanosclerosis Perforation

    Iatrogenic Cholesteatoma

    FACTORS AFFECTING TREATMENT


    Age Duration Unilateral or bilateral Degree of hearing impairment Previous treatment Associated conditions Tympanic membrane changes Others

    SEQUELAE
    Spontaneous resolution
    50% resolve within 3 months. Only 5% persists for more than 12 months

    Tympanosclerosis Scarring, retraction and atelectasis Cholesteatoma

    Conclusion
    OME is very common in children Etiology is associated with ET dysfunction and or chronic infection In adults: Nasopharyngeal pathology should be considered Most cases resolve spontaneously Conservative treatment is of doubtful value VT insertion restore hearing in the selected cases

    Classification of Chronic Otitis Media


    Chronic Non Suppurative Otitis Media
    Otitis media with effusion OME Adhesive otitis media

    Chronic Suppurative Otitis Media CSOM


    Tubo-tympanic (Safe) Attico-antral (Unsafe)

    Chronic Adhesive Otitis Media


    Formation of adhesion in the middle ear after reactivation and subsequent healing of either CSOM or OME

    Clinical Features
    History of CSOM or OME Deafness is usually the only symptoms TM shows various structural changes

    Treatment
    Observation Surgical treatment Hearing aid

    Classification of Chronic Otitis Media


    Chronic Non Suppurative Otitis Media
    Otitis media with effusion OME Adhesive otitis media

    Chronic Suppurative Otitis Media CSOM


    Tubo-tympanic (Safe) Attico-antral (Unsafe)

    CHRONIC SUPPURATIVE OTITIS MEDIA

    ETIOLOGY
    Environmental Genetic Previous OM Upper respiratory tract infections Eustachian tube dysfunction

    CLINICO-PATHOLOGICAL TYPES

    Tubo-tympanic

    Attico-antral

    PATHOLOGY
    Signs of suppurative infection
    Discharge & perforation Chronic inflammatory reaction in the mucosa and the bone (ostietis)

    Signs of healing attempts


    Granulation tissue & polyps Fibrosis & tympanosclerosis

    Cholesteatoma (attico-antral type)

    CHOLESTEATOMA

    DEFINITION
    The presence of a desquamating stratified squamous epithelium in the middle ear

    PATHOGENESIS OF CHOLESTEATOMA
    Implantation (congenital or acquired) Metaplasia Epithelial migration

    CLASSIFICATION OF CHOLESTEATOMA
    Congenital Acquired
    Primary Secondary

    Effect of Cholesteatoma
    Keratin encourages persistence of the infection Matrix causes bone erosion

    Clinical Features of CSOM

    CLINICO-PATHOLOGICAL TYPES

    Tubo-tympanic

    Attico-antral (cholesteatoma)

    SYMPTOMS OF CSOM
    Otorrhea
    Intermittent, profuse & odorless in TT type Persistent, scanty & malodorous in AA type

    Deafness Tinnitus N.B. Any other symptom means complication

    OTOSCOPIC EXAMINATION
    Discharge
    Present in TT type if active but may be absent Usually is present in AA type

    Perforation
    Central: in TT type Marginal or attic in AA type with cholesteatoma

    PERFORATION IN TT CSOM

    PERFORATION IN AA CSOM

    OTOSCOPIC EXAMINATION
    Discharge
    Present in TT type if active but may be absent Usually is present in AA type

    Perforation
    Central: in TT type Marginal or attic in AA type with cholesteatoma

    Polyps, granulation tissue, tympanosclerosis

    Bacteriology
    B A P S P K e r o b s e t a r o le u e s d a c t e A r io l o n a e g y r o b e s ea s c u p t ia

    o m o n a s p h y lo c o c c u t e u s b s i e ll a a n d

    a e a r c u t ge ir n o oi d s B s P a e u p r t eo uc so c P e p t o s t r e E s c h e r ic h

    INVESTIGATIONS
    Audiometry Bacteriology Imaging

    Congenital Cholesteatoma

    Cloudy middle ear in CSOM

    Cholesteatoma with attic erosion

    TREATMENT OF CHRONIC SUPPURATIVE OTITIS MEDIA


    Depends on the type and presentation

    Active TT type

    Inactive TT type

    Attico-antral type (usually active)

    Conservative treatment

    Active TT type

    Inactive TT type

    Conservative Treatment Treat any predisposing factor Keep the ear dry TYMPANOPLASTY Ear toilet Antibiotics Removal of polyps and granulations

    TYMPANOPLASTY
    An operation performed to eradicate disease in the middle ear cavity and to reconstruct the hearing mechanism

    MYRINGOPLASTY
    An operation performed tympanic membrane to repair the

    AIMS OF TYMPANOPLASTY
    To close the perforation To prevent re-infection To improve hearing

    TREATMENT OF ATTICOANTRAL CSOM


    Removal of cholesteatoma by mastoid operation

    RADICAL MASTOIDECTOMY
    An operation in which the mastoid antrum and air cells, attic and middle ear are converted into common cavity, exteriorized to the external canal. The tympanic membrane, malleus and incus are removed leaving only the stapes in situ.

    MODIFIED RADICAL MASTOIDECTOMY


    An operation in which the mastoid antrum and air cells, attic and middle ear are converted into common cavity, exteriorized to the external canal. The tympanic membrane and ossicles remnants are retained

    AIMS OF RADICAL & MODIFIED RADICAL MASTOIDECTOMY


    Safety Dry ear Preserve hearing

    Conclusion
    In TT type the discharge is usually copious, intermittent and odorless. The perforation is central. Treatment is conservative (if there is active infection) followed by tympanoplasty to prevent re-infection and improve hearing. In the AA type the discharge is usually scanty, persistent and of bad odor. The perforation is attic or marginal with cholesteatoma. Treatment is by mastoidectomy to provide safety and dry ear

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