Sara's Presentation

SARA IMTIAZ
MALIK
TITLE: CSOM AND ITS TYPES
Introduction
Types of COSM
Aetiology
Pathology
Bacteriology
Clinical features
Assessment
Treatment
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INTRODUCTION
Chronic suppurative otitis media it is one of the most common childhood

infectious diseases worldwide and is a common cause of hearing
impairment in resource-limited settingsIt is characterized by chronic
drainage from the middle ear associated with tympanic membrane
perforation CSOM is usually preceded by an episode of acute otitis media
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ANATOMY
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TWO TYPES
• Tubotympanic/mucosal
• Atticoantral/sqamosal
PRESENTATION TITLE 5
Atticoantral type
• Involves the pars flacida or posterosuperior marginal quadrant.
• Also called “unsafe” type due to potential for dangerous intracranial
complications, most commonly caused by cholesteatoma.
• Discharge usually persistent.
• May have moderate to severe hearing loss, potentially resulting in
permanent deafness
Tubotympanic type
• Involves the pars tensa.
• Also called “safe” type as less likely to result in serious intracranial
complications (such as meningitis and brain abscess) compared with attico-
antral type.
• Discharge is mainly mucoid or mucopurulent and intermittent.
• Often associated with respiratory tract infection.
• May have mild hearing loss.
RISK FACTORS
• Low socioeconomic status
• Prolonged symptom duration before seeking medical attention
• Cholesteatoma
• Infection caused by multidrug resistant bacteria
• Underlying HIV infection
A.TUBOTYMPANIC TYPE
Aetiology
1. Untreated acute otitis media
2. Ascending infection trough eustachian tube
3. Allergy to milk eggs fish
Pathology
1. It remains localized to mucosa in anteroinferior part of middle
ear cleft
2. Central perforation in pars tensa
3. Middle ear mucosa normal when disease inactive and velvety
when disease active
4. Inflamed mucosa makes outgrowth or structure polyp which
protudes through perforation and present in external canal
5. Ossicular chain usually intact but may show some degree of
necrosis commonly long process of incus
6. Tympanosclerosis is hardening calcification and hyalinization
of remanents of tympanic membrane or tympanic membrane
itself
7. Fibrosis and adhesion as result of healing process
Clinical features
1. Ear discharge not foul smelling
2. Hearing loss conductive type
3. Perforation mainly central
4. Middle ear mucosa normally pale pink and moist when
inflamed it looks red
Assessment
1. Examination under microscope
2. Audiogram
3. Culture and sensitivity of ear discharge
4. Mastoid xray or high resolution ct scan temporal bone
Treatment
1. Aura toilet: remove all discharge from ear
2. Ear drops: antibiotic ear drops
3. Systemic antibiotics
4. Surgical treatment: Myrinoplasty Tympanoplasty
5. Precautions: do not wet ear
ATTICOANTRAL TYPE
Aetiology
1. Similar to cholesteatoma
2. Seen in sclerotic mastoid
Pathology
1. Cholesteatoma
2. Osteitis and granulation tissue
3. Ossicular necrosis
4. Ossicular necrosis (cholesteatoma hearer)
5. Cholesterol granuloma
Symptoms
1. Ear discharge foul smelling because of bone
necrosis
2. Hearing loss mostly conductive but
sensorineural element may be added
3. Bleeding may accur from polyp or granulation
tissue when cleaning
Signs
1. Attic or posterosuperior perforation
2. Retraction pocket( 4 stages)
Stage 1:tympanic membrane doesnot contact incus
Stage 2:TM contacts incus
Stage 3(middle ear atelectasis): TM lie on promontory and ossicles
Stage4(adhesive otitis media): TM is thin and wraps promontory and
ossicles
3. cholesteatoma
Assessment
1. Microscope examination
2. Tuning fork test and audiogram
3. X ray and ct scan
4. Culture and sentivity of ear discharge
Treatment
1. Canal wall up procedure: disease removed from combined
approach through the meatus and mastoid but retaining the
posterior bony metal wall intact avoiding open mastoid cavity.
It gives dry ear and easy reconstruction of hearing mechanism
2. Canal wall down procedure: leave mastoid cavity open into
external auditory canal so disease area is fully exteriorized.
Features indicating complications in csom
1. Pain
2. Vertigo
3. Persistent headache
4. Facial weakness
5. A listless child refusing to take feeds
6. Fever nausea vomiting
7. Irritibility neck rigidity
8. Diplopia
9. Ataxia
10. Abscess round the ear(mastoiditis)
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SARA IMTIAZ

Chronic suppurative otitis media it is one of the most common childhood

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