Chronic Otitis Media

Question 1

Definition

Answer 1

Follows an attack of acute otitis media if perforation and discharge persists > 3 months

Question 2

Aetiology

Answer 2

-Late/inadequate treatment of AOM
-Upper airway sepsis
-Lowered resistance
(Malnutrition, anaemia, immunological deficit)

Vast majority of cases in children 3-6 years of age

Question 3

Pathology

Answer 3

• Perforation generally occurs in PARS TENSA
• PARS FLACIDA is most prone to retraction & collection of squames to form a cholesteatoma as fibrous layer here is more disorganised and weaker

Question 4

Clinical Features

Answer 4

Deafness (conductive)
Speech and language delay
Otalgia
Recurrent infections

Dull, retracted tympanic membrane

Question 5

Investigations

Answer 5

• Audiogram & tympanogram
• Post-nasal space visualization to exclude tumour obstructing Eustachian tube orifice esp unilateral

IN TYMPANIC PERFORATION
-Should perform CN7 and CN8 exam to exclude associated lesions

Question 6

Management

Answer 6

MEDICAL
Topical antibiotics and steroids for 7 days
-Sofradex (dexamethasone, gramicidin)
-Gentisone HC (hydrocortisone & gentamicin)

SURGICAL

• Grommet insertion
• Adenoidectomy if sig nasal symptoms