Chronic Suppurative Chronic Suppurative Otitis MediaOtitis Media

Presented; MOHD YUSOF BIN YAMIN14 MAY 2008

CSOM

• CSOM is a long standing infection of a part or a whole of middle ear cleft characterized by ear discharge and permanent perforation.

middle ear

Types of CSOM

• Clinically, it is divided into 2 types;– Tubotympanic – Atticoantral

Features• Ear discharge– Non-offensive, mucoid or

mucopurulent.– Constant or intermittent– Discharge appears mostly when

URTI or water accidently enters the ear

• Hearing loss– Conductive type– In long standing, it can become

mixed type due to cochlea damage

Cont.

• Perforation– Always central– May lie ant., post. or inf. to

handle of malleus• Middle ear mucosa– Seen when perforation is large– Normally it is pale pink and

edematous red if inflammed– Sometimes polyp can be seen

Investigations

• Microscopic exam. of edge of perforation – granulation, in-growth squamous epithelium.

• Audiogram – to assess the degree of hearing loss and the type

• Culture and sensitivity of the ear discharge• Mastoid x-ray – mastiod usually sclerotic but

may be pneumatised with clouding of air cell, without bone destruction.

Radiogram showing sclerotic (poorly pneumatized) mastoid air cells.

Radiogram showing well-pneumatized mastoid air cells.

Treatment

• Aims – to control infection, eliminate ear discharge, correct hearing loss

1.Aural toilet– Remove all discharge and debris by mopping

with cotton wool, suction clearance under microscope, and irrigation

Cont.

2. Ear drops– Antibiotic ear drops containing neomycin,

polymyxin, chloromycetin or gentamicin.– They are combined with steroids which has anti-

inflammatory effect

3. systemic antibiotic– Useful in acute exacerbation of chronically

infected ear.

Cont.

4. Precautions to patient– Keep water out of ear during bathing, swimming– Avoid hard nose blowing – may push the

infection in nasopharynx to middle ear

5. Treat the contributory cause – infected tonsil, adenoids, maxillary antra, nasal allergy

Cont.

5. Surgical treatment – if there is aural polyps or granulation is present

6. Reconstructive surgery – Myringoplasty with or without ossiculoplasty