CSOM TUBO TYMPANIC DISEASE
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Chronic Suppurative Otitis Media (CSOM) is a persistent ear infection characterized by discharge and perforation of the eardrum, primarily affecting individuals in developing countries due to poor health conditions. It has various types based on discharge characteristics, complications, and audiometric findings, with potential causes including prior acute otitis media and allergies. Treatment focuses on infection control, removal of discharge, and restoring hearing through medical or surgical interventions.
CSOM TUBO TYMPANIC DISEASE
- 2. DEFINITION CSOM is a long standing infection of a part or whole of middle ear cleft characterised by ear discharge and permanent perforation.
- 3. EPIDEMIOLOGY Higher in developing countries - poor socioeconomic standards - poor nutrition - lack of health education Affects both sexes All age groups
- 4. TYPES Tubotympanic Atticoantral Discharge Profuse, mucoid, Scanty, Purulent, odourless foul smelling Perforation Central Attic or Marginal Polyp Pale Red and fleshy Cholesteatoma Absent Present Granulations Uncommon Common Complications Rare Common Audiogram Mild CD CD or Mixed
- 5. TUBOTYMPANIC Aetiology Sequela of acute otitis media Ascending infections via eustachian tube from infected tonsils, adenoids, infected sinuses Allergy to ingestants such as milk, egg,fish etc.
- 6. PATHOLOGICAL CHANGES 1. Perforation of Pars tensa central perforation 2. Middle ear mucosa inactive – normal active – oedematous and velvety
- 7. 3. Polyp smooth mass of oedematous and inflammed mucosa ; pale 4. Ossicular chain intact and mobile necrosis of long process of incus
- 8. 5. Tympanosclerosis hyalinisation and calcification of subepithelial conn. tissue. white chalky deposits on ossicles, promontory, joints, tendons, ov al window and round window. 6. Fibrosis and adhesions due to healing process
- 9. BACTERIOLOGY Aerobic Ps. aeruginosa Proteus E coli Staph aureus Anaerobic Bact. fragilis Anaerobic streptococci
- 10. CLINICAL FEATURES 1. Ear discharge Non offensive, mucoid or mucopurulent. Constant or intermittent. 2. Perforation Central - anterior, posterior or inferior to handle of malleus. Small, medium or large.
- 11. 3. Hearing loss Conductive Round window shielding effect Hears better in the presence of discharge than dry ear. Long standing cases – mixed type 4. Middle ear mucosa Pale pink and moist – normal Red oedematous and swollen - inflammed
- 12. INVESTIGATIONS 1. Examination under microscope Granulations Status of ossicular chain Ingrowth of sq epithelium from edges of perforation Tympanosclerosis Adhesions
- 13. 2. Audiogram Conductive hearing loss 3. Culture and sensitivity of ear discharge Select proper antibiotic ear drops 4. Mastoid X-rays Usually sclerotic but may be pneumatised with clouding of air cells No bone destruction
- 14. TREATMENT to control infection eliminate ear discharge correct hearing loss
- 15. 1. Aural toilet - remove discharge and debris from ear dry mopping with absorbent cotton buds suction clearance under microscope irrigation with sterile NS
- 16. 2. Ear drops Neomycin, Polymyxin, Chloromycetin, Gentamycin Steroids 3. Systemic antibiotics a/c exacerbation of c/c infected ear
- 17. 4. Precautions keep water out of ear hard nose blowing avoided 5. Treatment of contributory cause infected tonsils, adenoids, nasal allergy
- 18. 6. Surgical treatment aural polyps and granulations if present 7. Reconstructive surgery myringoplasty