CSOMCHRONIC SUPPURATIVE OTITIS

MEDIA

BASSAM KHALID

DEFINITION

“ LONG STANDING(more than 3 months) INFECTION OF A PART OR WHOLE OF THE MIDDLE EAR CLEFT , CHARACTERIZED BY CONSTANT OR INTERMITTENT EAR DISCHARGE AND A PERMANENT PERFORATION IN TYMPANIC MEMBRANE “

TYMPANIC MEMBRANE

• IT FORMS THE PARTITION BETWEEN THE EXTERNAL AUDITORY CANAL AND THE MIDDLE EAR

• PARTS

• PARS TENSA• PARS FLACCIDA

LAYERS OF TYMPANIC MEMBRANE

• OUTER EPITHELIAL LAYER

• INNER MUCOSAL LAYER

• MIDDLE FIBROUS LAYER

MIDDLE EAR

THE MIDDLE EAR TOGETHER WITH THE EUSTATION TUBE , ADITIUS , ANTRUM AND MASTOID EAR CELLS IS CALLED MIDDLE EAR CLEFT

PARTS• MESOTYMPANUM

• EPITYMPANUM

• HYPOTYMPANUM

• PROTYMPANUM

TYPES OF CSOM

• TUBOTYMPANIC ( SAFE OR BENIGN TYPE )

• ATTICOANTRAL ( UNSAFE OR DANGEROUS TYPE )

TUBOTYMPANIC TYPE

AETIOLOGY

• SEQUELA OF ACUTE OTITIS MEDIA

• ASCENDING INFECTIONS VIA EUSTACHIAN TUBE

• ALLERGY

• TRAUMATIC PERFORATION

PATHOLOGY

• PERFORATION OF TYMPANIC MEMBRANE (central)

• PERSISTANT OR INTERMITTENT EAR DISCHARGE

• EPITHELIALIZATION OF MARGINS OF PERFORATION

• POLYPS• GRANULATIONS

• OSSICULAR CHAIN NECROSIS

BACTERIOLOGY

• STREPTOCOCCI

• STAPH AUREUS

• E.COLI

• P.AERUGINOSA

• B.FRAGILIS

GRAM POSITIVE

GRAM NEGATIVE

BACTEROIDES

• EAR DISCHARGE

• PAIN

• HEARING LOSS

SYMPTOMS

SIGNS• PERFORATION

• MIDDLE EAR MUCOSA• Normal Or pale looking Polyps• Red velvety mucosa(active disease)

• TUNING FORK TESTS• RINNE’S TEST• WEBERS TEST

INVESTIGATIONS

• PUS SWAB FOR CULTURE SENSITIVITY

• PURE TONE AUDIOGRAM Type of hearing loss Severity of hearing loss • MASTOID X-RAY

TREATMENT

• AURAL TOILET

• EAR DROPS

• ANTIBIOTICS

• SURGICAL TREATMENT• MYRINGOPLASTY• TYMPANOPLASTY• OSSICULOPLASTY• SURGERY OF NOSE THROAT

ATTICOANTRAL TYPE

• CHOLESTEATOMA

• OSTEITIS

• GRANULATION TISSUE

• OSSICULAR NECROSIS

• CHOLESTEROL GRANULOMA

PATHOLOGY

CHOLESTEATOMA

• Congenital cell rests

• Invagination of tympanic membrane

• Basal cell hyperplasia

• Metaplasia

• Epithelial invasion

BACTERIOLOGY

• STREPTOCOCCI

• STAPH AUREUS

• E.COLI

• P.AERUGINOSA

• B.FRAGILIS

GRAM POSITIVE

GRAM NEGATIVE

BACTEROIDES

SYMPTOMS

• EAR DISCHARGE

• BLEEDING

• DECREASED HEARING

SIGNS

• PERFORATION

• RETRACTION POCKET

• CHOLESTEATOMA

MARGINAL PERFORATION

INVESTIGATIONS

• PURE TONE AUDIOGRAM

• X-RAY MASTOID

• CT SCAN PETROMASTOID AREA

• PUS SWAB FOR CULTURE

COMPLICATIONS

• INTRA TEMPORAL

• INTRA CRANIAL

INTRATEMPORAL

• MASTOIDITIS• PETROSITIS• FACIAL PARALYSIS• LABRYINTHITIS

INTRACRANIAL

• EXTRADURAL ABSCESS• SUBDURAL ABSCESS• MENINGITIS• BRAIN ABSCESS• LATERAL SINUS THROMBOPHLEBITIS• OTITIC HYDROCEPHALUS

TREATMENT

• MEDICAL• Aural Toilet• Broad Spectrum Antibiotics

• SURGICAL• MASTOIDECTOMY

. CANAL WALL UP PROCEDURE

. CANAL WALL DOWN PROCEDURE

• TYMPANOPLASTY

THANK YOU