CHOLESTEATOMA AND CHRONIC SUPPURATIVE OTITIS MEDIA
CHOLESTEATOMA
Normally middle ear cleft linings: Ciliated columnar in anterior and inferior part. Cuboidal in middle part. There is nowhere lined by keratinising squamous epithelium in middle ear cleft. Presence of this epithelium in middle ear is called cholesteatoma(skin in the wrong place)
ORIGIN OF CHOLESTEATOMA1)Presence of congenital cell rests.
2)Invagination TM from attic or posterosuperior part of pars tensa in the form of retraction pockets(wittmacck’s theory).3)Basal cell hyperplasia(Rueid’s theory)
4)Epithelial invasion(Habermann’s theory)
5)Metaplasia(Sade’s theory)
CLASSIFICATION OF CHOLESTEATOMA
1.CONGENITAL
2.ACQUIRED,PRIMARY
3.ACQUIRED,SECONDARY
EUSTACHIAN TUBE OBSTRUCTION
PERSISTENT NEGATIVE PRESSURE IN MIDDLE EAR
ATTIC OR POSTERIOSUPERIOR RETRACTION POCKET
METAPLASIA OF
MIDDLE EAR
MUCOSA
PROLIFERATION OF BASAL LAYER
PRIMARY ACQUIRED CHOLESTEATOMA
SUBCLINICAL INFECTIONS OF
MIDDLE EAR
REPEATED INFECTION THROUGH
PERFORATION
METAPLASIA OF MIDDLE EAR MUCOSA
LARGE CENTRAL OR MARGINAL
PERFORATION
ACUTE NECROTIZING OTITIS MEDIA
EPITHELIAL MIGRATION THROUGH
PERFORATION
SECONDARY ACQUIRED
CHOLESTEATOMA
Expansion of cholesteatoma and destruction of bone
Once cholestetoma enters middle ear cleft , it invades surrounding structures,first by following the path of least resistance, and then by enzymatic bone destruction which is caused by collagenase , acid phosphatase and proteolytic enzymes which are liberated by osteoclasts and mononuclear inflammatory cells.
CHRONIC SUPPURATIVE OTITIS MEDIA
It is long standing infection of a part or whole of the middle ear cleft , characterised by ear discharge and permanent perforation .
Epidemiology:Higher incidence in developing countries.Both sexes and all age group s are affected.Singlemost imp. Cause of hearing loss.
TYPES OF CSOM
A)Tubotympanic : Also called safe or benign type . Involves antero inferior part with central perforation.
B)Atticoantral : Also called unsafe or dangerous type . Involves the posterosuperior part and is associated with an attic or marginal perforation . Often associated with bone eroding process.
A)TUBOTYMPANIC TYPE
Pathology:1)Perforation of pars tensa2)Middle ear mucosa3)Polyp4)Ossicular chain5)Tympanosclerosis6)Fibrosis and adhesions
Bacteriology
Pseudomonas aeruginosa , proteus , E.coli and staph aerus.
Bacteroides fragilis and streptococci.
Clinical Features:1)Ear discharge : non offensive mucoid or
mucopurulent.2)Hearing loss3)Perforation4)Middle ear mucosa:Red oedematous and swollen.
INVESTIGATIONS:
1)Examination under microscope2)Audiogram3)Culture and sensitivity of ear discharge4)Mastoid X-rays.
TREATMENT:
Aural Toilet.Ear drops.Systemic antibiotics.Precautions.Treatment of contributory causes.Surgical treatment.Reconstructive surgery.
B)ATTICOANTRAL TYPE
Pathology:CholesteatomaOsteitis and granulation tissueOssicular necrosisCholesterol granuloma
SYMPTOMS:Ear discharge.Hearing loss.Bleeding.SIGNS:Perforation.Retraction pocket.Cholesteatoma
INVESTIGATIONS:
1)Tunning fork test2)Audiogram3)X-ray mastoids and CT scan of temporal bone.4)Culture and sensitivity of ear discharge.
TREATMENT:
1)Surgical:
2)Reconstructive surgery:
3)Conservative Treatment:
TUBERCULAR OTITIS MEDIA
SYPHILITIC OTITIS MEDIA
WILL BE CONTINUED AFTER 10 MIN BREAK