chronic otitis meedia Flashcards
what are the two main types of chronic otitis media?
mucosal type and squamous type
what are the features of the mucosal type of chronic otitis media?
recurrent or persistent ear infection in the presence of a tympanic membrane perforation , previously known as safe type
what are the features of squamous type of chronic otitis media ?
gross retraction of thee tympanic membrane with formation of a keratin collection ( el heeya el cholesteatoma), previously known as the unsafe type
what are the types of mucosal chronic otitis media ?
active mucosal - wet perforation with inflamed middle ear mucosa and discharge
inactive mucosal - dry perforation
what are the types of squamous chronic otitis ?
inactive squamous - retraction pocket , which has the potential to become active
active squamous - cholesteatoma
what are the causes of mucosal chronic otitis media ?
chronic inflammation due to persistent tympanic membrane perforation secondary to acute otitis media
what is the most common age group associated with Mucosal COM ?
children and adults
what are the most common pathogens associated with mucosal chronic otitis media ?
pseudomonas aeruginosa
Staphylococcus Aureus
what are the symptoms of mucosal chronic otitis media ?
hearing loss
otorrhea: persistent or intermittent, profuse, mucopurulent or mucoid
what are the signs of the mucosal inactive type ?
dry perforation with thin pale pink middle ear mucosa
what are the signs of thee mucosal active type ?
wet perforation with middle ear inflammation, middle ear mucosa is oedematous and congested
what are the complications of mucosal chronic otitis meedia ?
mastoiditis
intracranial complications
facial nerve palsy
what are the investigations done in cases of mucosal chronic otitis media ?
pure tone audiometry
swab from the external auditory canal
CT scan of temporal bone if complications are suspected
what is the treatment for mucosal chronic otitis media ?
medical - aural toilet with repeated microsuction
ab and steroid combination ear drops if discharge is present
surgical - myringoplasty , surgical repair of the tympanic membrane using cartilage or fascia
what is the pathology associated with squamous chronic otitis media ?
the squamous cells hyper proliferate and secrete osteolytic enzymes and can lead to secondary bacterial infections
what are the types of cholesteatoma ?
acquired and congenital
what are the causes of acquired cholesteatoma ?
retraction pocket ; retraction of thee tympanic membrane happens due to eustachian tube dysfunction
or
due to chronic perforation
how is a congenital cholesteatoma diagnosed ?
diagnosed in children who have an intact tympanic membrane and no history of ear surgery
what are the symptoms of squamous chronic otitis media ?
persistent and sometimes recurrent scanty offensive discharge
hearing loss
what are the signs of squamous chronic otitis media ?
retraction pocket
adjacent bony erosion
keratin debris within the pocket
purulent discharge with foul odour
granulations
middle ear polyp
TM perforation - if acquired
what does congenital squamous chronic otitis media look like ?
Tympanic membrane is intact with whitish pearly mass behind in congenital cholesteatoma
what are the investigations for squamous chronic otitis media ?
pure tone audiometry
swab for the external auditory canal
CT scan of temporal bone
what is the treatment for sq COM ?
surgical only
mastoidectomy
recurrent ear discharge with hearing loss is associated with ?
chronic otitis media
