Csom 090615124432 Phpapp01

Chronic suppurative otitis
media
Dr. T. Balasubramanian M.S. D.L.O.
www.drtbalu.com
Definition
CSOM is defined as a
chronic infection of
middle ear mucosa
lining the middle ear
cleft
The duration of
infection should be
more than 3 weeks
Middle ear cleft
includes eustachean
tube, middle ear
proper and mastoid
air cell system
www.drtbalu.com
Tubotympanic disease
Also known as
safe ear
It does not cause
any serious
complications
Infection limited
to the antero
inferior part of
middle ear cleft
Associated with
central perforation
www.drtbalu.com
Why is Tubotympanic
disease safe?
There is no risk of bone erosion
Not known to cause intracranial
complications
Discharge from middle ear flows freely
through the perforation in the pars
tensa
Usually the perforation of pars tensa is
surrounded by a rim of intact drum
The annulus is intact in all these cases
www.drtbalu.com
Aetiology
Inadequately treated ASOM
ASOM causing persistent perforation (Persistent

perforation syndrome)
Presence of focal sepsis in Nose / throat causing EC
Infected traumatic central perforation
www.drtbalu.com
Microbiology
Gram negative bacilli has been
commonly isolated
Ps. aeruginosa, E. coli, and B. proteus
These organisms are not commonly
found in the respiratory tract
These organisms are commonly
found in the skin of external canal
Always number your slides

www.drtbalu.com
Clinical features
Discharge is profuse and Mucopurulent
It is not foul smelling
Since the infected area is open at both
ends discharge doesn't accumulate in
the middle ear cavity
Ossicular chain is mostly uninvolved
Pts have conductive deafness 30 40
dB
Pain is usually due to otitis externa
www.drtbalu.com
Stages of Tubotympanic
disease
Acute stage
Inactive stage
Quiescent stage
Healed stage
www.drtbalu.com
Acute stage
Ear is actively discharging
Middle ear mucosa
hypertrophied and congested
The ear discharge is
Mucopurulent
Discharge is not foul smelling
www.drtbalu.com
Inactive stage
Dry perforation of ear drum +
Perforation involves the pars tensa
Annulus is intact
Middle ear mucosa is normal and
healthy
www.drtbalu.com
Quiescent stage
Perforation of ear drum present
Middle ear is dry
Middle ear mucosa may be normal /
hypertrophied
Discharge stopped just a few days back
www.drtbalu.com
Healed stage
Healing of drum by thin scar

Tympanosclerotic patches may be
seen
Ossicular chain invariably intact
www.drtbalu.com
Tuning fork tests
Rinne negative on the affected

side
Weber lateralized to deaf ear
ABC - Not reduced

www.drtbalu.com
Pure tone audiometry

Shows conductive hearing loss
Hearing loss commonly ranges
between 30 - 40 dB
If hearing loss exceeds 60 dB then
ossicular chain disruption should be
suspected
Associated sensorineural loss
should arouse suspicion of toxic
deafness
www.drtbalu.com
Conservative
management
Aural toileting - in active disease
Suction clearance
Syringing of affected ear using warm
saline mixed with 1.5 % acetic acid
Topical antibiotics administered after
culture report becomes available
Ear drops is administered by
displacement method
www.drtbalu.com
Role of systemic drugs

Antibiotics
Antihistamines
Ototoxic drugs to be avoided
Nasal decongestants ? Rhinitis
medicamentosa
www.drtbalu.com
Precautions
The ear must be kept dry
Pre-existing sinus infections to
be treated aggressively
Presence of focal sepsis in the
throat should also be managed
www.drtbalu.com
Surgical management
Surgery towards eradication of
focal sepsis
Surgery aimed towards
eradication of middle ear disease
(Mastoidectomy)
Surgery aimed at reconstruction
of sound conduction mechanism
(Myringoplasty and
tympanoplasty)
www.drtbalu.com
Tympanoplasty
Tympanoplasty is defined as the

surgical procedure which enables
reconstruction of middle ear cavity
and ossicular system. It also
involves reconstruction of the
perforated ear drum
www.drtbalu.com
Components of
tympanoplasty
Canalplasty
Meatoplasty
Myringoplasty
Ossiculoplasty
www.drtbalu.com
Canalplasty
This procedure is used to widen the
external canal
Should be performed before grafting
anterior perforations
This procedure facilitates better
healing
External canal can be cleansed
without any difficulty
Useful when performing second
stage ossiculoplasty
www.drtbalu.com
Meatoplasty
This procedure is performed to
enlarge the lateral cartilagenous
portion of the external canal
This enlargement should be in
proportion to the size of the bony
portion of the external canal
www.drtbalu.com
Ossiculoplasty
Used to reconstruct the damaged
ossicles of middle ear cavity
Long process of incus is found to be
commonly eroded
TORP
PORP
www.drtbalu.com
Aims of tympanoplasty
Disease eradication
Restoration of middle ear aeration
Reconstruction of sound conduction
mechanism
Creation of self cleansing dry cavity
www.drtbalu.com
Preop investigations
Tubal function tests
Audiometric evaluation
X-ray / CT scan of temporal
bones
Tests for anesthetic fitness
www.drtbalu.com
Trans canal surgical

approach
Performed through
ear speculum
inserted into the
ear canal
Ear canal should
be wide
There should not be
any bony overhang
obscuring the
edges of
perforation
www.drtbalu.com
End aural approach
Incision is made
between tragus and
helix
End aural speculum is
used
Posterior bony
overhang can easily be
drilled out
Better for anterior
visualization of the ear
drum
www.drtbalu.com
Endaural view of ear

drum
www.drtbalu.com
Post aural approach
Used in cases of
narrow external
canal
Used to close
anterior ear drum
perforations
William Wilds
post aural incision
is used
www.drtbalu.com
Ideal Tympanic membrane

grafts
Temporalis fascia
Dura
Periosteum
www.drtbalu.com
Why temporalis fascia is

favoured?
It has a low basal metabolic rate
Its thickness more or less resembles
that of normal ear drum
It can be harvested through the
same post aural incision
It is available in plenty
It has a good take rate
www.drtbalu.com
Types of grafting
techniques
Overlay technique
Underlay technique
Interlay technique
www.drtbalu.com
Underlay technique
Commonly used technique
The graft is placed under the
tympanic membrane remnant
and bone
To facilitate this process a
tympanomeatal flap will have to
be elevated
www.drtbalu.com
Overlay technique
The graft is placed over the

bony tympanic sulcus
A bony ledge is created for this
purpose if the sulcus is absent
The overlaid graft is supported
by the remnant ear drum if
present
www.drtbalu.com
Underlay technique
www.drtbalu.com
www.drtbalu.com

Csom 090615124432 Phpapp01

Uploaded by

Copyright:

Available Formats

Csom 090615124432 Phpapp01

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Csom 090615124432 Phpapp01

Uploaded by

Copyright:

Available Formats

Chronic suppurative otitis

Dr. T. Balasubramanian M.S. D.L.O.

ASOM causing persistent perforation (Persistent

Always number your slides

Healing of drum by thin scar

Tuning fork tests

Rinne negative on the affected

Weber lateralized to deaf ear

ABC - Not reduced

Pure tone audiometry

Role of systemic drugs

Tympanoplasty is defined as the

Trans canal surgical

End aural approach

Endaural view of ear

Post aural approach

Ideal Tympanic membrane

Why temporalis fascia is

The graft is placed over the

You might also like