CSOM Flashcards
CSOM (chronic suppurative otitis media)
Discharge and perforation of middle ear cleft.
Permanent perforation when edges covered by squamous epithelium.
Single most important cause of hearing impairment.
Types
Tubotympanic / safe / benign
Atticoantral / unsafe / dangerous
Etiology of tubotympanic type
Sequela of acute otitis media
Infections
Eustachian tube
Adenoids , tonsils, sinuses
Persistent mucoid otorrhoea
Pathology of tubotympanic type
Pars tensa perforation
Middle ear mucosa (oedema + velvety)
Polyp (pink fleshy)
Ossicular chain (necrosis)
Tympanosclerosis (hyalinization + calcification)(white chalky deposit)
Fibrosis and adhesions
Bacteria causing tubotympanic type
P aeruginosa, proteus, E coli, S aureus
Bacteroides fragilis
Anaerobic Strep
Clinical features of tubotympanic type
Discharge (offensive, mucoid / mucopurulent)
Hearing loss (conductive <50dB)(round window shielding effect)(phase differential)
Perforation (central)(ant./Post/inferior to handle of malleus)
Middle ear mucosa(pale pink, moist /red, edematous, swiollen)(polyp seen)
Assessment of tubotympanic type
Microscopy (granulation)(squmous epithelium growth)(ossicular chain )(tympanosclerosis)(adhesions)(hidden discharge)(cholesteatoma + central perforation)
Audiogram (conductive + sensoneural segment)
Culture of discharge
Mastoid x ray / HRCT (mastoid sclerosis/ pneumatized with clouding of air cells)
Tt of tubotymapnic type
Aural toilet
Ear drops (ciprofloxacin, ofoxacin, steroids)(maceration of canal, allergy, fungal growth, resistance of organism)
1.5% acetic acid irrigation
Precautions (rubber insert)
Systemic antibiotics
Surgery (aural polyp / granulations)
Reconstructive surgery (myringoplasty)
Etiology of Atticoantral type (posterosuperior)
With cholesteatoma
Sclerotic mastoid
Pathology of atticoantral type
Cholesteatoma
Osteitis + granulation tissue (mass fills attic, antrum, tympanum, mastoid)(fleshy red polypus)
Ossicular necrosis (stapes superstructure, handle of malleus, ossicular chain)(bidging, cholesteatoma hearer)
Cholesterol granuloma (foreign body giant cell)(haemorhhage / secretion)(appears blue with dark, viscid fluid)
Symptoms of atticoantral type
Discharge (scanty, foul smelling)(perforation sealed by crusted discharge, inflammatory mucosa, polyp, obstruction)
Hearing loss (conductive + sensoneural element)(normal in cholesteatoma bridging)
Bleeding (from granulation tissue / polyp)
Signs of atticoantral type
Perforation (attic / posterosuperior marginal type)(masked by granuloma or crusted discharge)
Retraction pocket (attic / posterosuperior area)(early- shallow, self cleaning)(later- deep, accumulates keratin mass, infected)(4 stages)
Cholesteatoma (pearly white flakes)
Stages of retraction pocket
1- tympanic membrane retracted
2-retracted deep, contacts incus
3/middle ear atelectasis-
Tympanic membrane lie on promontary and ossicles.
Middle ear space obliterated
Middle ear mucosa intact
Tympanic membrane thin (collagenous middle layer absorbed)(balloons up on N2O anaesthesia)
4/adhesive otitis media
Membrane (thin, wraps and adhere to promontary , ossicles)
Middle ear space absent
Mucosal lining absent
Retraction pocket collect keratin plugs forming cholesteatoma)
Erosion-long process of incus,stapes)
Assesment of atticoantral type
Microscopy (cholesteatoma, bone destruction, granuloma, ossicles, discharge from pockets)
Mastoid X ray/HRCT temporal bone (degree of mastoid pneumatization, indicate low lying dura, antiposed sigmoid sinus)
Audiogram
Tunning fork test
Culture
Features indicating complications in CSOM
Pain (extradural, perisinus, brain abscess)(otitis externa,petrositis)
Vertigo (erosion lateral semicircular canal)(labyrinthitis, meningitis)
Headache
Facial weakness (erosion facial canal)
Fever
Nausea+ vomit
Feed refusal
Neck rigidity
Irritability
Diplopia (petrositis, intracranial presdure)
Ataxia (labyrinthitis,cerebellar abscess)
Mastoiditis (abscess round the ear)
