Chronic Suppurative Otitis Media

Classification of Chronic Otitis Mediay

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

y

Chronic Suppurative Otitis Media CSOMTubotympanic (Safe) Atticoantral (Unsafe)

CHOLESTEATOMA

DEFINITIONy

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

PATHOGENESIS OF CHOLESTEATOMAy

Implantation (congenital or acquired)

y

Metaplasia Epithelial migration

y

CLASSIFICATION OF CHOLESTEATOMAy Congenital y Acquired

Primary Secondary

Effect of Cholesteatomay

Keratin encourages persistence of the infection

y

Matrix causes bone erosion

Clinical Features of CSOM

CLINICOCLINICO-PATHOLOGICAL TYPES

Tubo-tympanic

Attico-antral (cholesteatoma)

SYMPTOMS OF CSOMy

OtorrheaIntermittent, profuse & odorless in TT type Persistent, scanty & malodorous in AA type

y y

Deafness Tinnitus complication

N.B. Any other symptom means

OTOSCOPIC EXAMINATIONy

DischargePresent in TT type if active but may be absent Usually is present in AA type

y

PerforationCentral: in TT type Marginal or attic in AA type with cholesteatoma

PERFORATION IN AA CSOM

OTOSCOPIC EXAMINATIONy

DischargePresent in TT type if active but may be absent Usually is present in AA type

y

PerforationCentral: in TT type Marginal or attic in AA type with cholesteatoma

y

Polyps, granulation tissue, tympanosclerosis

BacteriologyBacteriology

Aerobes Pseudomonas aeruginosa Staphylococcus aureus Proteus Klebsiella and Escherichia coli

Anaerobes Bacteroides Peptococcus Peptostreptococcus

INVESTIGATIONSy

Audiometry Bacteriology Imaging

y

y

Congenital Cholesteatoma

Cloudy middle ear in CSOM

Cholesteatoma with attic erosion

TREATMENT OF CHRONIC SUPPURATIVE OTITIS MEDIA

y Depends

on the type and presentation

Active TT type

Inactive TT type

Attico-antral type (usually active)

TREATMENT OF ATTICOATTICOANTRAL CSOMRemoval of cholesteatoma by mastoid operation

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

membrane retained

remnants

AIMS OF RADICAL & MODIFIED RADICAL MASTOIDECTOMYy y y

Safety Dry ear Preserve hearing

Conclusiony

y

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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