Chronic Suppurative Otitis Media (C.S.O.M.) (COM)

Chronic Suppurative Otitis
Media
(C.S.O.M.)(COM)
Khalid Hussain Mahida
Department of ORL-HNS
Ziauddin University Karachi Pakistan
History
 A 32 year old male reported to ENT OPD with long
standing ear discharge and decreased hearing from
Left ear,
 The problem is intermittent and always started
following upper RTI or after swimming.
 It resolved after a course of antibiotics and ear drops
advised by his GP
 He desired a permanent solution for this problem
Exam.
 The Right ear is normal
 The left ear examination reveals a large central perforation
 Hearing loss was of conductive type

demonstrate by Tuning fork test
 Rest of the nose, throat ,Vestibular and limited

neurological examination were normal
Investigations
 Pure Tone audiometry shows moderate
conductive hearing loss
 Pus c/s shows growth of Pseudomonas

aerugenosa sensitive to Quinolones and amino
glycosides group
Treatment
 Tab Ciprofloxacin 250mg BD for 10 days
 Tobaramycin- Dexamethasone ear drops twice daily
 Water precautions
 Follow-up after 10 days if Inactive then date

for Tympanoplasty
C.S.O.M.
 Chronic inflammation of Middle ear
 Irreversible changes in Mucosa
 Disease extends beyond mucosa to underlying
bone
 Basically a surgical disease
C.S.O.M.-Definition
It is a persistent disease of the middle ear cleft,

insidious in onset, capable of causing sever
destruction and irreversible sequelae, and
clinically manifests with deafness and
discharge
C.S.O.M.- Classification
C.S.O.M.
Tubo-Tympanic Attico-Antral
Active Inactive Active Inactive

Diagnostic Categories on the
basis of Otomicroscopy
 Healed COM
 Inactive mucosal COM
 Active Mucosal COM
 Inactive (squamous) retractions
 Active (Squamous )Cholesteatoma
Healed COM
Healed COM
Inactive Mucosa;
Active Mucosal
Active Mcosal
Inactive (squamous) retractions
Active
(Squamous)Cholesteatoma
C.S.O.M.- Tubotympanic
 Also called as Safe type of CSOM
 H/O long standing uni/bilateral ear discharge
associated with deafness
 Active , when the ear is discharging
 Inactive , when the ear is dry
C.S.O.M.- Tubotympanic-Active
 Preceding URTI/swimming
 Anterior pulsatile, profuse, mucoid or
mucopurulent non-odorous ear discharge
 Nidus of infection in URT
 Perforation is central
C.S.O.M.- Tubotympanic-Inactive
 Symptom free
 Mild to moderate conductive hearing loss
 Dry central perforation
C.S.O.M.- Attico Antral
 Cholesteatoma
 Unsafe CSOM, dangerous type
 Ear discharge is scanty(profuse in mixed
infection)
 Discharge is malodorous
 The ear is seldom dry
 Deafness is conductive
Cholesteatoma
 A cholesteatoma is a three-dimensional
epidermal structure exhibiting independent
growth, replacing middle ear mucosa,
resorbing underlying bone and tending to recur
after removal.
 Simply it is bad skin in the middle ear
C.S.O.M.- Attico Antral
 Presence of following indicates complications

* blood stained discharge
* facial palsy
* pain
* vertigo
* Headach
Pathology and Classification
 Non-neoplastic accumulation of keratinizing
stratified squamous epithelium with
desquamated keratin debris
 Subepithelial fibroconnective tissue
 Granulation tissue
 Bone destruction
 Elaboration of collagenase and other
inflammatory mediators
C.S.O.M.- Evaluation
 History-long h/o ear
complaints
 Physical examination-
-otoscopy
-otomicroscopy
 Hearing Assessment
 Pus C/S
Otomicroscopy
 Imaging-
 assessment of mastoid disease,
-X-ray mastoid
-CT Scan
 Bacteriology
* Pseudomonas aerugenosa
* Proteus mirabilis
* E coli
* S.aureus
* G-ve/anaerobes
Audiology-CHL
-PTA/Speech
Audiometry
C.S.O.M.- Tubotympanic Management
Ciprofloxacin
 Aural toilet- Ofloxacin
 Antimicrobial agents Gentamycin Hydrocortisone
 Eliminate any nidus of infection in UR
 Prevent water from gaining access in to the ear
 Myringo/Tympanoplasty/ossiculoplasty, if the
ear becomes inactive
Modified radical mastoidectomy
Combine approach
tympanoplasty

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Chronic Suppurative Otitis

 The left ear examination reveals a large central perforation

 Hearing loss was of conductive type

 Rest of the nose, throat ,Vestibular and limited

 Pus c/s shows growth of Pseudomonas

 Tobaramycin- Dexamethasone ear drops twice daily

 Follow-up after 10 days if Inactive then date

It is a persistent disease of the middle ear cleft,

Active Inactive Active Inactive

 Presence of following indicates complications

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