CSOM - TUBOTYMPANIC

DEFINITION

CSOM is a long standing infection of a part or whole of middle ear cleft characterised by ear discharge and permanent perforation.

EPIDEMIOLOGYHigher in developing countries

- poor socioeconomic standards- poor nutrition- lack of health education

Affects both sexes

All age groups

TYPES Tubotympanic

Atticoantral

Discharge Profuse, mucoid, Scanty, Purulent,

odourless foul smellingPerforation Central Attic or MarginalPolyp Pale Red and fleshyCholesteatoma Absent PresentGranulations UncommonCommonComplications Rare CommonAudiogram Mild CD CD or Mixed

TUBOTYMPANIC Aetiology

Sequela of acute otitis mediaAscending infections via eustachian tube from infected tonsils, adenoids, infected sinusesAllergy to ingestants such as milk, egg,fish etc.

PATHOLOGICAL CHANGES

1. Perforation of Pars tensa central perforation

2. Middle ear mucosa inactive – normal active – oedematous and velvety

3. Polyp smooth mass of oedematous

and inflammed mucosa ; pale

4. Ossicular chain

intact and mobile necrosis of long process of

incus

5. Tympanosclerosis hyalinisation and calcification

of subepithelial conn. tissue. white chalky deposits on

ossicles, promontory, joints, tendons, oval window and round window.

6. Fibrosis and adhesions due to healing process

BACTERIOLOGY

Aerobic Ps. aeruginosa Proteus E coli Staph aureusAnaerobic Bact. fragilis Anaerobic streptococci

CLINICAL FEATURES

1. Ear discharge Non offensive, mucoid or mucopurulent.Constant or intermittent.

2. PerforationCentral - anterior, posterior or inferior to handle of malleus.Small, medium or large.

3. Hearing lossConductive Round window shielding effectHears better in the presence of

discharge than dry ear.Long standing cases – mixed type

4. Middle ear mucosaPale pink and moist – normal

Red oedematous and swollen - inflammed

INVESTIGATIONS1.Examination under microscope

Granulations Status of ossicular chain Ingrowth of sq epithelium from

edges of perforation

Tympanosclerosis Adhesions

2. AudiogramConductive hearing loss

3. Culture and sensitivity of ear discharge

Select proper antibiotic ear drops

4. Mastoid X-raysUsually sclerotic but may be pneumatised with clouding of air cellsNo bone destruction

TREATMENT

Aim to control infectioneliminate ear dischargecorrect hearing loss

1. Aural toilet

- remove discharge and debris from ear dry mopping with absorbent cotton

buds suction clearance under microscope irrigation with sterile NS

2. Ear drops Neomycin, Polymyxin, Chloromycetin, Gentamycin Steroids

3. Systemic antibioticsa/c exacerbation of c/c infected ear

4. Precautionskeep water out of earhard nose blowing avoided

5. Treatment of contributory cause

infected tonsils, adenoids, nasal allergy

6. Surgical treatmentaural polyps and granulations if

present

7. Reconstructive surgerymyringoplasty