CSOM Flashcards
Def
Long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation.
Permanent one= squamous epithelium
Types
Tubotympanic Anteroinferior et+mesotympanum Associated w central perforation Atticoantral Posterosup part of cleft Attic or marginal perforation Cholesteatoma Granulations Osteitis
TT
Sequels of acute otitis media
Follows exanthemous fever. Leaves behind a large central perforation
Acute otitis media
Persistent mucoid otorrhea
Pathology of TT
Perforation of pars tensa Middle ear mucosa Polyp Ossicular chain Tympanic clerks is Fibrosis and adhesions
Bacteria
Pseudomonas Proteus E coli Staph Aureus B. Fragilis Streptococcus anaerobic
Other classification
mucosal disease with
no evidence of invasion of squamous epithelium. It is called
“active” when there is a perforation of pars tensa with inflam-
mation of mucosa and mucopurulent discharge. It is called
“inactive” when there is a permanent perforation of pars
tensa but middle ear mucosa is not inflamed and there is no
discharge.
Permanent perforation
Permanent perforation sq epi-
thelium on the external surface of pars tensa and mucosa lin-
ing its inner surface have fused across its edge.
Healed chronic
otitis media is the condition when tympanic membrane has
healed (usually by two layers), is atrophic and easily retracted
if there is negative pressure in the middle ear. Associated w conductive hearing loss
AA disease
squamosal disease of
middle ear. It may be “inactive” when there are retraction
pockets in pars tensa or
pars flaccida.
squamous debris in retraction pockets to become infected and
start discharging. Some retraction pockets are shallow and
self-cleansing. “Active” squamosal disease of middle ear implies
presence of cholesteatoma of posterosuperior region of pars
tensa or in the pars flaccida. It erodes bone, forms granulation
tissue and has purulent offensive discharge
Clinical features
Ear discharge. Hearing loss Perforation Middle ear mucosa Microscopy audiogram Culture and sensitivity Mastoid x ray
Treatment
Aural toilet Antibiotics Surgery Contributory causes Cosmetic reconstruction
