Download - Csom by Bssam Khalid
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CSOMCHRONIC SUPPURATIVE OTITIS
MEDIA
BASSAM KHALID
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DEFINITION
“ LONG STANDING(more than 3 months) INFECTION OF A PART OR WHOLE OF THE MIDDLE EAR CLEFT , CHARACTERIZED BY CONSTANT OR INTERMITTENT EAR DISCHARGE AND A PERMANENT PERFORATION IN TYMPANIC MEMBRANE “
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TYMPANIC MEMBRANE
• IT FORMS THE PARTITION BETWEEN THE EXTERNAL AUDITORY CANAL AND THE MIDDLE EAR
• PARTS
• PARS TENSA• PARS FLACCIDA
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LAYERS OF TYMPANIC MEMBRANE
• OUTER EPITHELIAL LAYER
• INNER MUCOSAL LAYER
• MIDDLE FIBROUS LAYER
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MIDDLE EAR
THE MIDDLE EAR TOGETHER WITH THE EUSTATION TUBE , ADITIUS , ANTRUM AND MASTOID EAR CELLS IS CALLED MIDDLE EAR CLEFT
PARTS• MESOTYMPANUM
• EPITYMPANUM
• HYPOTYMPANUM
• PROTYMPANUM
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TYPES OF CSOM
• TUBOTYMPANIC ( SAFE OR BENIGN TYPE )
• ATTICOANTRAL ( UNSAFE OR DANGEROUS TYPE )
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TUBOTYMPANIC TYPE
AETIOLOGY
• SEQUELA OF ACUTE OTITIS MEDIA
• ASCENDING INFECTIONS VIA EUSTACHIAN TUBE
• ALLERGY
• TRAUMATIC PERFORATION
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PATHOLOGY
• PERFORATION OF TYMPANIC MEMBRANE (central)
• PERSISTANT OR INTERMITTENT EAR DISCHARGE
• EPITHELIALIZATION OF MARGINS OF PERFORATION
• POLYPS• GRANULATIONS
• OSSICULAR CHAIN NECROSIS
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BACTERIOLOGY
• STREPTOCOCCI
• STAPH AUREUS
• E.COLI
• P.AERUGINOSA
• B.FRAGILIS
GRAM POSITIVE
GRAM NEGATIVE
BACTEROIDES
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• EAR DISCHARGE
• PAIN
• HEARING LOSS
SYMPTOMS
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SIGNS• PERFORATION
• MIDDLE EAR MUCOSA• Normal Or pale looking Polyps• Red velvety mucosa(active disease)
• TUNING FORK TESTS• RINNE’S TEST• WEBERS TEST
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INVESTIGATIONS
• PUS SWAB FOR CULTURE SENSITIVITY
• PURE TONE AUDIOGRAM Type of hearing loss Severity of hearing loss • MASTOID X-RAY
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TREATMENT
• AURAL TOILET
• EAR DROPS
• ANTIBIOTICS
• SURGICAL TREATMENT• MYRINGOPLASTY• TYMPANOPLASTY• OSSICULOPLASTY• SURGERY OF NOSE THROAT
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ATTICOANTRAL TYPE
• CHOLESTEATOMA
• OSTEITIS
• GRANULATION TISSUE
• OSSICULAR NECROSIS
• CHOLESTEROL GRANULOMA
PATHOLOGY
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CHOLESTEATOMA
• Congenital cell rests
• Invagination of tympanic membrane
• Basal cell hyperplasia
• Metaplasia
• Epithelial invasion
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BACTERIOLOGY
• STREPTOCOCCI
• STAPH AUREUS
• E.COLI
• P.AERUGINOSA
• B.FRAGILIS
GRAM POSITIVE
GRAM NEGATIVE
BACTEROIDES
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SYMPTOMS
• EAR DISCHARGE
• BLEEDING
• DECREASED HEARING
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SIGNS
• PERFORATION
• RETRACTION POCKET
• CHOLESTEATOMA
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MARGINAL PERFORATION
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INVESTIGATIONS
• PURE TONE AUDIOGRAM
• X-RAY MASTOID
• CT SCAN PETROMASTOID AREA
• PUS SWAB FOR CULTURE
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COMPLICATIONS
• INTRA TEMPORAL
• INTRA CRANIAL
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INTRATEMPORAL
• MASTOIDITIS• PETROSITIS• FACIAL PARALYSIS• LABRYINTHITIS
INTRACRANIAL
• EXTRADURAL ABSCESS• SUBDURAL ABSCESS• MENINGITIS• BRAIN ABSCESS• LATERAL SINUS THROMBOPHLEBITIS• OTITIC HYDROCEPHALUS
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TREATMENT
• MEDICAL• Aural Toilet• Broad Spectrum Antibiotics
• SURGICAL• MASTOIDECTOMY
. CANAL WALL UP PROCEDURE
. CANAL WALL DOWN PROCEDURE
• TYMPANOPLASTY
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THANK YOU