Chronic Otitis Media

Question 1

What is chronic otitis media?

Answer 1

2 types of chronic otitis media:

1. Mucosal: a tympanic membrane perforation in the presence of recurrent or persistent ear infection
2. Squamous: gross retraction of the tympanic membrane with formation of a keratin collection (cholesteatoma)

Disease may be active (infection present) or inactive (no infection)

=> Inactive mucosal: dry perforation

=> Inactive squamous: Retraction pocket, potential to become active with retained debris (keratin)

=> Active mucosal: wet perforation with inflamed middle ear mucosa and discharge

=> Active squamous: cholesteatoma

Question 2

What is mucosal chronic otitis media?

Answer 2

Occurs in children and adults

Causes:

1. Chronic infection following development of a post-infective, traumatic or iatrogenic perforation
2. Pathogens i.e. pseudomonas aeruginosa, staph. aureus

Question 3

What are the signs and symptoms of mucosal chronic otitis media?

Answer 3

Hearing loss

Otorrhoea (may be present with active disease)

Mucosal inactive: dry perforation

Mucosal active: wet perforation with middle ear inflammation

May develop secondary to otitis externa due to discharge

Question 4

Complications same as otitis media.

Answer 4

Check otitis media for complications

Question 5

What investigations are carried out for chronic otitis media?

Answer 5

Pure tone audiometry

Ear swab for microscopy culture & sensitivity

Question 6

How is chronic otitis media treated?

Answer 6

Aural toilet with microsuction ensuring the whole tympanic membrane is visualised

Antibiotic + steroid combination ear drops if infection present

Myringoplasty (Type 1 tympanoplasty) => surgical repair of the tympanic membrane perforation using cartilage or fascia
=> indicated to prevent recurrent otitis media