Chronic otitis media
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Transcript of Chronic otitis media
Chronic otitis mediaDr. AJAY MANICKAMJUNIOR RESIDENTDEPARTMENT OF OTOLARYNGOLOGYRG KAR MEDICAL COLLEGE
COMCHRONIC INFLAMATION OF THE
MUCO-PERIOSTEAL LINING OF THE MIDDLE EAR CLEFT
Tubotympanic / safe
type Atticoantral / Unsafe type
Tubotympanic typeSafe typeInactive / Active / Healed
mucosal typePredisposing factors 1. Inadequate treatment of AOM2. Infection of Nose, naso or
oropharynx3. Tuberculosis4. Sclerotic mastoids
COM aetiologyStreptococcusStaphylococcusGram negative organisms like pseudomonas, proteus, E coli
Pathogenesis Middle ear mucosa became
edematous and velvety in active disease Ossicular chain may undergo necrosis, particularly the long process of incus
Hyalinization and subsequent calcification of sub epithelial connective tissue leading to
Symptoms Discharge – profuse, mucoid, nonpurulent, increasing with attack of cold
Deafness – mild conductiveEarache – otitis externa if associated
Signs Discharge in the EACCentral Perforation – usually pars
tensaTuning fork test – rhinne negative
weber lateralised to affected side
Central perforation Subtotal perforation
Total perforation
Investigations Pus for C/SExamination with otoscope /
microscopePTAX-ray of mastoids [lat obq]X-ray of PNS X-ray nasopharynx Diagnostic nasal endoscopy
Management Medical 1. Aural toilet – dry mopping
, suction clearance under microscope
2. Antibiotic ear drops 3. Systemic antibiotics if
acute exacerbation of the disease
Surgical managementRemoval of septic
foci – tonsillectomy , adenoidectomy , sinus clearance
Myringoplasty Tympanoplasty If associated
mastoiditis – cortical mastoidectomy
Atticoantral diseaseCHOLESTEATOMA skin in the
wrong place – sac in the middle ear which is lined by keratinizing squamous epithelium containg desquamated epithelium as keratin debris Congenital Acquired
1. Primary2. Secondary
Theories of cholesteatomaRetraction
pocket theoryTheory of
migrationMetaplasia
theoryImplantation
theory
Pathogenesis of cholesteatoma
Tubal occlusion BEZOLD
Embryonic cell remnant WITTMACK
Epithelial embryonic
cell Mc KENZIE
Negative attic pressure
Attic retraction pocket
Squamous epithelium in middle ear
Normal pavement epithelium TUMARKIN
Epithelial metaplasia
CHOLESTEATOMA
Symptoms Ear discharge – foul smelling
scanty predominantly purulent occasionally blood stained
Deafness Itching and pain in the ear – with
otitis externa Tinnitus & giddiness – early
symptoms of complication
Signs Attic, marginal or total perforation Granulation tissue or keratin flakes in
the postero superior quadrant of deep meatus
Tuning fork test – rinne negative , weber lateralized to the affected side
Investigations Examination under microscope C/S from dischargeRigid oto endoscopy – to see
facial recess and sinus tympani if possible
PTAX-ray mastoid schuller’s & laws
viewHRCT temporal bone
Management Primary – make ear safeRestore hearingMaintain anatomical appearance
of earMedical management – no role or
patients unfit for surgery . 5 flurouracil has been tried – regular follow up
Main line of management is SURGERY
SURGERYCanal wall down mastoidectomy
– radical or modified radicalCanal wall up mastoidectomy –
combined approach tympanoplasty