Pathophysiology and

Complications of CSOM
• Also called chronic active mucosal otitis media, chronic oto-
mastoiditis, and chronic tympanomastoiditis.
• a chronic inflammation of the middle ear and mastoid cavity, which
presents with recurrent ear discharges or otorrhoea through a
tympanic perforation.
Classification
• Tipe Tubotimpani (tipe mukosa/benigna/tanpa kolesteatoma)
• Tipe Atik-koantral (tipe tulang/dengan kolesteatoma)
PATOFISIOLOGI TUBOTYMPHANI

1. INFEKSI (RHINITIS, SINUSITIS, ADENOIDITIS)

2. EDEMA DAN INFLAMASI
3. COLONISASI MENYEBAR KE EUSTACHIAN TUBE
4. INFLAMASI DI EUSTACHIAN TUBE
5. ACCUMULATION MUCOUS & DYSFUNCTION EUSTACHIAN TUBE
6. BAKTERI BERMIGRASI KE MIDDLE EAR
7. OTITIS MEDIA ACUTE (PROLONGED)
8. NEGATIVE PRESSURE IN MIDDLE EAR
9. PERFORATION TYMPANIC MEMBRANE
10. CSOM
PATOFISIOLOGI ATTIC-COANTRAL

1. Adanya hiperproliferasi keratinosit disertai akumulasi deskuamasi

epitel atau keratin di dalam telinga tengah atau bagian lain tulang
temporal yang berpneumatisasi, yang bersifat progresif dan
destruktif.
2. Perforasi tymphanic membrane
3. CSOM
Complications
The chronic infection may result in permanent conductive hearing
loss because of damage to the ossicles, and sensorineural loss may also
occur
Chronic suppurative otitis media can also progress into one or more
of the intratemporal (extracranial) suppurative complications (acute
mastoiditis, acute labyrinthitis, facial paralysis)
Mastoiditis
Mastoiditis is an infection of otitis media which infection spread from
tympanic antrum to the bony walls of the cell of mastoid process.
a. Acute mastoiditis
b. Chronic mastoiditis
Mastoiditis adalah segala proses peradangan pada sel - sel mastoid
yang terletak pada tulang temporal.
Infection in the mastoid proceeds after middle-ear infection through
the following stages:
■ Hyperemia and edema of the mucosal lining of the pneumatized cells
■ Accumulation of serous and then purulent exudates in the cells
■ Demineralization of the cellular walls and necrosis of bone
■ Formation of abscess cavities owing to coalescence of adjacent cells
after destruction of cell walls
■ Escape of pus into contiguous areas
Anamnesis
• Riwayat otitis media lebih dari 3 minggu
• Otorea / cairan keluar dari telinga
• Otalgia / sakit telinga belakang
• Demam
• Sakit kepala
• Penurunan pendengaran
Pemeriksaan Fisik
• Edema retroaurikular
• Erithema pada telinga
• Nyeri pada prosesus mastoid
• Pada pemeriksaan otoskop : tanda2 otitis media, protrusi sentral
membran timpani
Penatalaksanaan
A. Mastoiditis akut tanpa osteitis/periosteitis
- Selfotaksim 50 – 180 mg/kg/hari hingga 1 g IV, diberi setiap 4 jam
- Seftriakson 50 – 75 mg/kg/hari hingga 1 g IV, diberi setiap 12 jam
B. Mastoiditis akut dengan osteitis
- Mastoidektomi
- Antibiotik IV (vankomisin 2 g IV perhari dibagi 2 sampai 4 kali perhari)
Petrositis
• Petrositis (apical petrositis) is a relatively rare suppurative
complication secondary to an extension of infection from the middle
ear and mastoid into the petrous portion of the temporal bone
The organisms that cause acute petrositis are the same as those that cause
acute mastoid osteitis: S. pneumoniae, H. influenzae, and group A streptococci
Diagnosis :
• pain behind the ear,
• deep ear pain,
• persistent ear discharge,
• sixth nerve palsy. Paralysis of the sixth cranial nerve leading to diplopia is a
late complication
• A discharge from the ear is common with acute petrositis but may not be
present with chronic disease
LABYRINTHITIS

• This complication of otitis media occurs when infection spreads into

the cochlear and vestibular apparatus. The usual portal of entry is the
round window or, less commonly, the oval window
Schuknecht classified labyrinthitis into three types :
1. Serous (toxic) labyrinthitis, in which there may be bacterial toxins or
biochemical involvement, but no bacteria are present
2. Suppurative (acute and chronic otogenic suppurative) labyrinthitis, in
which bacteria have invaded the otic capsule
3. Meningogenic suppurative labyrinthitis, which is the result of
invasion of bacteria from the subarachnoid space into the labyrinth
Acute Serous Labyrinth

Bacterial toxins from the infection in the middle ear may enter the
inner ear, primarily through an intact round window or through a
congenital defect between the middle ear and inner ear
Sign and symptom

• progressive, or fluctuating sensorineural hearing loss

• Vertigo
• The loss of hearing is usually mixed, that is, there are both conductive
and sensorineural components
Facial Paralysis

• Facial paralysis, as a complication of otitis media and related diseases

• Facial weakness, otalgia, otorrhea, concomitant upper respiratory
tract symptoms of infection, and fever were the most common
symptoms.
External Otitis

Otitis media with perforation can be associated with an infection of the

external auditory canal secondary to a discharge from the middle ear
and mastoid.
OE merupakan infeksi pada kulit dua seeprtiga dalam liang telinga
ditandai dengan telinga hiperemis,edema tidak berbatas tegas.
Etiology
• Pseudomonas aeruginosa
• Staphylococcus aureus
• Staphylococcus albus
• Eschericia coli
• Proteus mirabilis
faktor predisposisi : sering berenang, iklum hangat dan lembab, liang
telinga sempit,trauma ,sumbatan serumen, DM
Patogenesis
• Faktor predisposisi -> edema stratum korneum-> penumbuhan bakteri
-> edema dan nyeri -> otitis eksterna
Diagnosis
• The ear canal skin is erythematous, edematous, and filled with
purulent drainage and yellow-crusted plaques, and a perforation of
the eardrum (or tympanostomy tube) is present.