Chronic Suppurative Otitis Media

Dr. Gangaprasad Waghmare

MS

Chronic Suppurative Otitis Media

• Chronic inflamation of middle ear causing

irreversible changes like perforation

• Can cause deafness

• Seen mostly in low socio-economic people

Causes • Attack of ME infection

• Measels, diptheria, inflenza infection

• Disorders of ventilation

• Retraction pocket formation

• Long standing SOM

• Bacteriological

Types

• Tubo tympanic

• Attico antral

Tubo Tympanic

• Involves antero inferior part of me

• Sread of infection from septic focci near

naso pharynx like

Rhinitis

Tonsilitis

Sinusitis

Adenoids

From external ear through perforated ear

drum

Malnutrition & hypogamaglobulinaemia

Clinical featurs

• Recurrent otorrhea: watery & mucoid

• Deafness: conductive type

• Pain: absent

• Otoscopy : perforation of tympanic

membrane

• Infection like :rhinitis, sinusitis,adenoids

Pathological changes

• Perforation : central perforation due to

necrosis of part having less blood supply

• Ossicles : discontinuity of chain due to

necrosis

• Tympano sclerosis : white chalky deposit

on ossicular joint due to hyline

degenaration

• Polyp : from perforated ear drum

Investigation

• Tuning fork test

• Audiogram

• Radiology: no evidence of erosion

treatment

• Septic focci

• Aural toilet

• Antibiotic ear drops

• Systemic antibiotics

• Surgical: polyp should surgically removed

tympanoplasty

Attico antral or Tympano Mastoid

• Postero superior part of ME

• Pathalogical changes : formation of

cholesteotoma

• polyps

• granuation

• partial or total necrosis

Cholesteotoma

• Shining white mass

• Contains desquamated epithelium with

cheesy odour

• It is not a tumor its a skin in wrong place

Formation

• Acquired :

Increase ME pressure with OM

Increase Negative pressure

Retraction of pars flacida

Pouch neck get closed

Sac and skin get localised

• Invasion : growth of epithelium from

external auditory canal

• Metaplasia: metaplasia of epithelium of

middle ear cleft due to suppuration

Bone erodation

• By liberation of chemical

• Ischaemic necrosis theory

• Enzymatic theory: collagenase, acid

phoaphate and proteolytic enzyme

• Passes from aditus to antrum of mastoid

further spread causing many complication

• Hence called as dangerous om

Clinical Features

• Otorrhoea: scanty & foetid

• Deafness: conductive & mild initially

• Bleeding : from granulation or polyp

Otoscopic examination

• Perforation in pars flacida

• Granulation

• Cholesteatoma

• Cholesterol granuloma [black drum]

• Retraction pocket

• Symptoms of complication- earache,

vertigo, temporal headache, tinnitus, facial

palsy, abscess around ear.

Investigation

• Audiometry : Moderate to severe

conductive deafness

• Radiology: mastoid bone sclerosis with

bone erosion

• Culture & sensitivity of discharge

Treatment

• Ostruction of eustachian tube

• Aural toilet: a small cholesteoma can be

removed by suction

• Surgery : granulation polyp should be

surgically removed

mastoidectomy

Tympanoplasty