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Aravind Csom - Unsafe Ear

CSOM - UNSAFE EAR refers to a chronic suppurative otitis media infection located in the unsafe areas of the middle ear, specifically the attic and antrum regions. Key features include scanty purulent discharge, attic or marginal perforations, cholesteatoma, polyps, and granulations. The infection can cause osteitis, ossicular necrosis, and cholesterol granulomas. Treatment aims to eliminate the cholesteatoma, infection, perforation, and hearing loss through canal wall up or down mastoid surgeries along with topical and systemic antibiotics.

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Asfar Ahamed
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64 views

Aravind Csom - Unsafe Ear

CSOM - UNSAFE EAR refers to a chronic suppurative otitis media infection located in the unsafe areas of the middle ear, specifically the attic and antrum regions. Key features include scanty purulent discharge, attic or marginal perforations, cholesteatoma, polyps, and granulations. The infection can cause osteitis, ossicular necrosis, and cholesterol granulomas. Treatment aims to eliminate the cholesteatoma, infection, perforation, and hearing loss through canal wall up or down mastoid surgeries along with topical and systemic antibiotics.

Uploaded by

Asfar Ahamed
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CSOM - UNSAFE EAR

BY
ARAVIND

LEONATEZ
DEFNITION
• Chronic - long standing

• suppurative – pus producing infection

• otitis media – middle ear

• unsafe – POSTERO superior part


(attic and antrum)
AETIOLOGY

• ET dysfunction

• Poor aeration

• Mucosal edema and ulceration

• Capillary proliferation

• Osteitis
CHARACTERISTIC FEATURES
• EAR DISCHARGE – scanty, purulent,
foul-smelling
• PERFORATION - attic or marginal
• CHOLESTEATOMA
• POLYP – red & fleshy
• GRANULATIONS
pathology
• Cholesteatoma
• Osteitis & granulations
• Commonly involves outer attic wall & postero- superior
margin of tympanic rim

• Ossicular necrosis
• More common in long process of incus
• So hearing loss is more than in safe type
• Cholesterol granuloma

• Mass of granulation tissue with foreign body gaint cells


surrounding the cholesterol crystals

• it is a reaction to long standing retention of secretions or


hemmorhage
bacteriology
• Aerobic
• Pseudomonas
• Proteus
• E.coli
• Staph . Aureus
• Anaerobes
• Bacteroids fragilis
• Anaerobic streptococci
Symptoms
• Ear discharge
• Hearing loss
• Conductive deafness – ossicular necrosis

• Sn hearing loss – due to absorption of toxic materials into the


cochlea
• Bleeding
• From granulations & polyp
Signs
• Perforation
• Attic or posterosuperior marginal
• May masked by small granuloma
• Retraction pocket
• Invagination of tymp. Membrane
• Early stage – pocket – shallow & self cleansing
• Late stage – deep , accumulates secretions & gets infected
• cholesteatoma
investigationS
• Examination under microscope

• Tuning fork tests & audiogram

• X-ray mastoid / ct scan temporal bone

• Culture & sensitivity of ear discharge


treatment
• Aim :

– To treat

• the cholesteatoma

• Infection

• Perforation

• Haring loss
TREATMENT OF CHOLESTEATOMA

• CANAL WALL UP PROCEDURES

• Complete mastoidectomy

• CANAL WALL DOWN PROCEDURES

• Modified radical mastoidectomy

• Radical mastoidectomy
Treatment of infection

• Topical
– Ciprofloxacin (100% dry @ 21 days)
– Neomycin
– Polymyxin B
– Gentamicin,
– Tobramycin
– Steroid (Dexamethazone
hydrocortizone )
• Systemics

• Antistaphlococcal

• AntiPseudo

• Quinolones
RECONSTRUCTIVE SURGERY
• TO REsTORE THE HEARING

• BY MYRINGOPLASTY OR
TYMPANOPLASTY
CONSERVATIVE TREATMENT
• REPEATED SUCTION & CLEARANCE

• POLYPS & GRANULATIONS REMOVED BY


CUP FORCEPS OR CAUTERISED BY SILVER
NITRATE OR TRI CHLORO ACETIC ACID

• OTHERS – AURAL TOILET & DRY EAR


PRECAUTIONS
REFERENCE
• Diseases of ENT – Dhingra

• Textbook of ENT – Mohd. Maqbool

• Disease of ear – Harold Ludman


& Tony Wright
LEO
MESSI

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