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Chronic Otitis Media

Dr. Jitendra Patel


M.S. (ENT)

RAJ ENT HOSPITAL, 20/25, NEW JAGANATH, RAJKOT :360001 Mobile: +919824224272 doctorjitendra@yahoo.com
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Chronic Otitis Media

Definition:
Chronic inflammation of the mucosa of the middle ear cleft.( > 3 months)

Types:
1. Chronic Suppurative O.M. 2. Chronic Non-Suppurative O.M. 3. Chronic Specific O.M.
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Chronic Suppurative Otitis Media

Definition:
Chronic inflammation of the mucosa of the middle ear cleft produced by pus forming organisms.

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Chronic Suppurative Otitis Media

Types:
1. Benign/ Tubotympanic CSOM 2. Dangerous/ Attico antral CSOM

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Chronic Suppurative Otitis Media

Etiology:
1) Age: All 2) Sex: Both 3) Predisposing Factors: 1. A.O.M. which fails to heal 2. Traumatic Perforation 3. Congenital Cholesteatoma 4) Causative Organism: Benign: Strepto, Staphylo, Pneumo. Dangerous: Proteous, Psudomonas, Bacteroids
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Chronic Suppurative Otitis Media

Etiology:
5) General Factors: > Poor Hygiene, > Poverty/Lower socio-eco.class > Malnourishment 6) Etiology of Cogn. Cholesteatoma: Squamous Epi. Cell Rest Persist Cong. Cholesteatoma
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Chronic Suppurative Otitis Media

Etiology:
7) Etiology of Aquired Cholesteatoma: 1. Negative Pressor: 2. Invasive Theory: 3. Metaplasia:

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Chronic Suppurative Otitis Media

Pathology:
( Benign Type CSOM ) 2) Ossicals: 1) Tympanic Memb.:

3) Mastoid Bone:

4) Polyp:

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Chronic Suppurative Otitis Media

Pathology:
( Danger Type CSOM ) 1)Tympanic Memb.: 2) Ossicles:

3) Cholesteatoma:

4) Polyp

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Chronic Suppurative Otitis Media

Symptoms:
Symptoms
1. Otorrhoea

Benign CSOM
Intermittent, Profuse, Without foul smell, Increase with URTI Mild to Moderate May be Present May be Present May be Present if there is Acute inf. Or Comp.
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Dangerous CSOM
Continues, Scanty, With foul smell, Not affected by URTI Mild to Severe May be Present May be Present May be Present if there is Acute inf. Or Comp.
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2.Deafness 3.Tinitus 4.Vertigo 5.Otalgia

Chronic Suppurative Otitis Media

Signs:
Ear Examination
1. Otorrhoea 2.Deafness 3.Perforation 4.Cholesteatoma 5.Complication Sign

Benign CSOM
Profuse, Without foul smell, Conductive Central Absent Very Rare

Dangerous CSOM
Scanty, With foul smell, Conductive or Mixed Marginal Almost always Present Common

Nose & Throat Examination: Septic Foci may be Present


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Chronic Suppurative Otitis Media

Investigations:
1. Audiogram 2. Pus Culture & Sensitivity 3. X-Ray Both Mastoid
Benign CSOM - Sclerosis of Mastoid Danger CSOM Sclerosis with Erosion

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Chronic Suppurative Otitis Media

Treatment of Benign CSOM: Active Stage


Local Rx:
Ear Toilet Ear Drops Water should not enter

Systemic

Polypectomy / Granulations removal Rx: Antibiotic Mucolytic & Decongestant

Rx of septic focci : Tonsilectomy,


Septoplasty
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Chronic Suppurative Otitis Media

Treatment of Benign CSOM: Inactive Stage


Small Perforation :
Chemical cauterization
[ 50% Trichloro acetic Acid application Once a week for 3 week ]

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Chronic Suppurative Otitis Media

Treatment of Benign CSOM: Inactive Stage


Big Perforation :
Tympanoplasty
Definition: Reconstruction of TM Indications: Age, Benign, Conductive, Dry, ET fn. Contra indications: Opp. to indications Anesthesia: LA/GA
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Chronic Suppurative Otitis Media


Tympanoplasty

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Chronic Suppurative Otitis Media

Treatment of Danger CSOM: Only active Stage


Surgical Rx :
1) Definition: 1) Definition:

Radical Mastoidectomy Modified Radical Mastoidectomy

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Chronic Suppurative Otitis Media

Treatment of Danger CSOM:


Radical Mastoidectomy

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Ready for Quiz? Take Pen & Paper to write answers.


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Select the correct answer

Q 1: In which condition, erosion of mastoid occures?

A: C:

Acute otitis media

B: D:

Benign C.S.O.M Secretory Otitis Media

Dangerous C.S.O.M

1 / 10

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Select the correct answer

Q 2: In Benign C.S.O.M., TYMPANIC MEMBRANE shows...


A: C:
perforation

B: D:

cholesteatoma retraction pocket

fluid collection

2 / 10

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Select the correct answer

Q 3: Foul smelling discharge is a charectristic of....

A: C:

Benign C.S.O.M.

B: D:

cholesteatoma Fungal Otitis Externa

Acute otitis Media

3 / 10

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Select the correct answer

Q 4: Tympanoplasty can be done, if...

A: C:

Patient's age is more then 7 years

B: D:

Patient's age is more then 10 years

Patient's age is more then 14 years

Patient's age is more then 20 years

4 / 10

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Select the correct answer

Q 5: Tympanoplasty is contra-indicated in following condition except...


A: C:
discharging ear

B: Eustachen tube dysfunction D:

Acute otits media

big perforation

5 / 10

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Select the correct answer

Q 6: What is Radical Mastoidectomy?

A: Removal of mastoid bone C: removal of mastoid disease with ear disease

B: removal of mastoid disease D: removal of mastoid disease with


ear disease with some ossicles.
6 / 10

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Select the correct answer

Q 7: In dangerous C.S.O.M. site of perforation is...

A: C:

Posteroinferior

B: D:

Posterosuperior Anterosuperior

Anteroinferior

7 / 10

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Select the correct answer

Q 8: Which fascia is used in tympanoplasty?

A: C:

Deep cervical fascia

B:

pretracheal fascia

Temporalis fascia

D: Buccophariangeal fascia

8 / 10

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Select the correct answer

Q 9: in tympanoplasty...

A: Middle ear disease is removed C:

B: Ossicular chan is repaired D:

Perforation is closed

all of above

9 / 10

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Select the correct answer

Q 10: In active stage of Benign CSOM, choice of treatment is ...


A: C:
Mastoidectomy

B: D:

Tympanoplasty Myringotomy

Medical treatment

10 / 10

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Correct answers :

Q. 1: C Q. 2: A Q. 3: B Q. 4: C Q. 5: D

Q. 6: D Q. 7: B Q. 8: C Q. 9: D Q. 10: C

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Thank You

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