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A - MSRA ENT [6] > [13] Chronic Suppurative Otitis Media > Flashcards

[13] Chronic Suppurative Otitis Media Flashcards

1
Q

What is chronic suppurative otitis media?

A

Inflammation of the middle ear and mastoid cavity for at least 6 weeks

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2
Q

What is chronic otitis media characterised by?

A

Discharge from the middle ear through a perforated TM

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3
Q

What can chronic suppurative otitis media be divided into?

A

‘Safe’ and ‘Unsafe’

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4
Q

What is the division of chronic suppurative otitis media into ‘safe’ and ‘unsafe’ based on?

A

The risk of developing cholesteatoma

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5
Q

What constitutes a low risk of cholesteatoma development in chronic suppurative otitis media?

A

Perforation in the tubotympanic (anterio-inferior) part of the TM

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6
Q

What constitutes a high risk of cholesteatoma development in chronic suppurative otitis media?

A

Perforation in the atticoantral (postero-superior) aspect of the TM

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7
Q

What cycle underlies the pathology of chronic suppurative otitis media?

A

Inflammation -> Ulceration -> Infection -> Granulation

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8
Q

How does inflammation in chronic suppurative otitis media first occur?

A

Due to acute infection of the middle ear causing irritation

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9
Q

What does inflammation in the middle ear lead to in chronic suppurative otitis media?

A

Mucosal ulceration and breakdown of the epithelial lining

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10
Q

What happens as a result of the ulceration and epithelial breakdown in chronic suppurative otitis media?

A

Granuloma formation developing into polyps in the middle ear

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11
Q

What can happen due to the inflammation, ulceration and granulation in chronic suppurative otitis media?

A

Destruction of surrounding structures and complications

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12
Q

What may cause the perforation in chronic suppurative otitis media?

A
  • Trauma
  • Iatrogenic
  • Acute otitis media
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13
Q

How can perforation of TM occur iatrogenically?

A

Grommet placement

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14
Q

How does the bacteria enter the middle ear in chronic suppurative otitis media?

A

From the external auditory canal via the perforation

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15
Q

What are the most common causative organisms in chronic suppurative otitis media?

A
  • Pseudomonas aeruginosa
  • Staph. aureus
  • Proteus species
  • Klebsiella pneumoniae
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16
Q

What are the risk factors for developing chronic suppurative otitis media?

A
  • Multiple episodes of acute otitis media
  • Living in crowded conditions
  • Being a member of a large family
  • Attending daycare
  • Craniofacial abnormalities
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17
Q

What craniofacial abnormalities can increase the risk of chronic suppurative otitis media?

A
  • Cleft lip or palate
  • Down’s syndrome
  • Choanal atresia
  • Microcephaly
18
Q

How doe chronic suppurative otitis media present?

A
  • Chronic (>2 weeks) ear discharge
  • Absence of otalgia and fever
  • Conductive* hearing loss
  • History of perforation mechanism
19
Q
  • What does mixed hearing loss suggest?
A

Extensive disease

20
Q

What test should be performed in a patient with suspected chronic suppurative otitis media?

A
  • Audiogram

- Tympanometry

21
Q

What can make audiometry and tympanometry difficult?

A

Heavy discharge

22
Q

How is chronic suppurative otitis media usually diagnosed?

A

Clinically

23
Q

What additional test should be performed if there is suspicion of cholesteatoma development?

A

CT of petrous temporal bone

24
Q

What are the differentials of chronic suppurative otitis media?

A
  • Otitis externa
  • Foreign body
  • Impacted earwax
  • Cholesteatoma
  • Wegener’s granulomatosis
  • Neoplasm
25
Q

What are the initial mainstays of therapy for chronic suppurative otitis media?

A
  • Aural toileting

- Topical antibiotics and steroids

26
Q

When should aural toileting and topical therapies for chronic suppurative otitis media stop?

A

When symptoms are reduced or resovled

27
Q

What should the antibiotics used in chronic suppurative otitis media have activity against?

A
  • Gram -ve (especially pseudomonas)

- Gram +ve (especially S. aureus)

28
Q

What are the topical steroids used for in chronic suppurative otitis media?

A

Reduce granuloma formation

29
Q

What is systemic therapy reserved for in chronic suppurative otitis media?

A

Failure to respond to topical therapy

30
Q

What other treatment options are available in chronic suppurative otitis media?

A

Surgery

31
Q

What is the success of surgery in chronic suppurative otitis media dependent on ?

A
  • Size of perforation

- Site of perforation

32
Q

What is the aim of closing the perforation in chronic suppurative otitis media?

A
  • Relieve symptoms
  • Prevent recurrent infection
  • Potentially improve hearing
33
Q

What is the improvement in hearing post-surgery for chronic suppurative otitis media dependent upon?

A

Pre-operative state of the auditory apparatus

34
Q

What are the surgical options for chronic suppurative otitis media?

A
  • Myringoplasty

- Tympanoplasty

35
Q

What is a myringoplasty?

A

Closure of the perforation in the pars tense

36
Q

How is closure of the pars tense achieved inchronic suppurative otitis media?

A

Autologous graft harvested from the tragal cartilage or temporalis fascia

37
Q

What is tympanoplsty?

A
  • Myringoplasty combined with reconstruction of the ossicular chain
38
Q

What are the potential complications of chronic suppurative otitis media?

A
  • Sequelae of the condition
  • Intra-temporal complications
  • Intra-cranial complications
39
Q

What are the sequelae of chronic suppurative otitis media?

A
  • Hearing loss

- Tympanosclerosis

40
Q

What are the intra-temporal complications of chronic suppurative otitis media?

A
  • Petrositis
  • Facial paralysis
  • Labyrinthitis
41
Q

What are the intra-cranial complications of chronic suppurative otitis media?

A
  • Lateral sinus thrombophlebitis
  • Meningitis
  • Intracranial abscess

A - MSRA ENT [6] (22 decks)

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