chronic otitis media bastaninejad shahin, md, orl & hns
TRANSCRIPT
Chronic Otitis MediaChronic Otitis Media
Bastaninejad Shahin, MD, ORL & HNSBastaninejad Shahin, MD, ORL & HNS
COM with Cholesteatoma• Epidermal inclusion cyst of the ME or Mastoid
cavity• Classification:
– Congenital (usually Ante.Sup.): appear behind or within an intact TM
– Acquired (usually Post.Sup.): • Otorrhea often malodorous (Mixed>Anaerobes>Aerobes
1 bacteroides, 2 Pseudomonas,...)• Keratin debris in the center of the perforation• Acute flare up may resemble AEO• Vertigo, hearing loss, Facial nerve paralysis,...
Pathogenesis
• Congenital: originates from areas of keratinizing epithelium within a small area in the Anterior tympanum
• Acquired: – Invagination (ex vacuo theory – in OME or
eustachian dysfunction)– Basal cell hyperplasia– Epithelial ingrowth– Squamous metaplasia
* Retraction pocket Cholesteatoma (Sundhoff & Tos)Retraction pocket Cholesteatoma (Sundhoff & Tos)
*
Complications
• Hearing loss through: perforation, ossicular erosion (mainly incusmainly incus), otic capsule erosions (mainly LSCCmainly LSCC, labyrinthine fistula may be found in up to 10% of the cases)
• Facial nerve paralysis (acute/chronic)• Tegmen erosion brain hernia or CSF
leakage,...• Intracranial infections
Management
• Surgical (see next slide for anatomy)– Canal wall down (CWD)
• Advantage: recurrence is low• Disadvantage: mastoid cavity problem
– Canal wall up (CWU)• Adv.: physiologic position of TM, no mastoid cavity
problem• Disadv.: recurrence is high, often nedd second
stage exploration
COM without Choles.
• Permanent perforation of the TM with or without recurrent infection
• Hearing loss regarding to the perforation size:– Small perforation: Low Freq. Air Bone GAP– Large Perforation: Low+High freq. ABG
• Bacteriology: usually Mixed>Aerobes>Anaerobes
Management
• Medical (mainly topical, in refractory infections use systemic therapy with Ciprofloxacin,...)
• Surgery:– Tympanoplasty (dry perforation, less than
25dB ABG)– Tympanomastoidectomy (several episodes of
otorrhea, more than 25dB ABG)
Tympanosclerosis
• Acellular hyalin and calcified deposits accumulate within the TM and ME submucosa
• Pathogenesis:– Consequence of resolved otitis media of
trauma
• Ossicular fixation may occure (most frequently in the attic head of the malleus and incus)
Management
• Management is like COM without cholesteatoma, But ossicular fixation must be corrected simultaneously (except stapedius fixation)