Chronic Otitis Media and Cholesteatoma

Question 1

What is Chronic Otitis Media?

Answer 1

• Chronic infection of middle ear due to ongoing inflammatory response
• Recurrent episodes of Acute Otitis Media

Question 2

What are the causes of Chronic Otitis Media?

Answer 2

=> Mucosal Chronic Otitis Media:
- Inflammation due to perforation, which can present with discharge

=> Squamous Chronic Otitis Media:
- Discharge due to cholesteatoma

Question 3

What are the clinical features of Chronic Otitis Media?

Answer 3

• Chronically discharging ear for over 6 weeks with no fever or pain
• Tympanic membrane perforation
• Hearing loss

Question 4

What are the investigations in suspected Chronic Otitis Media?

Answer 4

=> Audiograms and Typmanometry

=> CT Scan if Cholesteatoma suspected

Question 5

What is the management of Chronic Otitis Media?

Answer 5

=> Topical steroids and antibiotics
- Amoxicillin/ Clavulanic acid

=> Surgical:

• Myringoplasty (closure of perforation)
• Tympanometry

Question 6

What is Cholesteatoma?

Answer 6

• Presence of keratinising squamous epithelium within the middle ear
• The squamous epithelium exhibits indépendant growth, leading to expansion and resorption of underlying bone

Question 7

What is External Canal Cholesteatoma?

Answer 7

Focal erosion of external canal bone with accumulation of keratin

Question 8

What are the risk factors of Cholesteatoma?

Answer 8

• Middle ear disease
• Eustachian tube dysfunction
• Otological surgery
• Traumatic blast surgery to ear
• Congenital Anomalies
• Family History

Question 9

What are the causes of Cholesteatoma?

Answer 9

=> Acquired:

• Retraction of pars flaccid, Epithelium becomes trapped and infected, proliferating to form cholesteatoma
• Migration of squamous epithelium through a defect in the tympanic membrane
• Implantation of visible keratinocytes in the middle ear post otological surgery
• Traumatic blast injury

=> Congenital:

• Invagination of the squamous epithelium from the developing ear canal
• Seeding of the middle ear by squamous cells in the amniotic fluid
• Epithelial in growth from the surface of the tympanic membrane

Question 10

What are the clinical features of Cholesteatoma?

Answer 10

• Tinitus
• Hearing loss
• Otalgia
• Discharge resistant to antibiotics
• Dizziness

Question 11

What is the differential diagnosis of Cholesteatoma?

Answer 11

• Chronic otitis Media
• Myringitis
• Benign necrotising otitis externa

Question 12

What are the investigations in suspected Cholesteatoma?

Answer 12

• Pure tone audiogram

- CT

Question 13

What is the management of Cholesteatoma?

Answer 13

• Surgery

- Pre-operative antibiotics