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Csom TT

The document discusses chronic suppurative otitis media (CSOM), including its classification, causes, symptoms, treatment options such as tympanoplasty surgery, and factors involved in tympanoplasty. CSOM is a chronic inflammatory process in the middle ear caused by bacterial infection that can cause permanent damage. Treatment aims to eliminate the disease, repair perforations, and control infections.

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8 views

Csom TT

The document discusses chronic suppurative otitis media (CSOM), including its classification, causes, symptoms, treatment options such as tympanoplasty surgery, and factors involved in tympanoplasty. CSOM is a chronic inflammatory process in the middle ear caused by bacterial infection that can cause permanent damage. Treatment aims to eliminate the disease, repair perforations, and control infections.

Uploaded by

nahidanila439
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Today’s topics-

Chronic suppurative Otitis Media


(CSOM)
Presented by –
Dr. Md. Mazharul Islam
Classification of Otitis Media
• A. Acute otitis media / acute suppurative otitis media.
• B. Chronic otitis media
1. Chronic non-suppurative otitis media / Otitis media with
effusion / glue ear.
2. Chronic suppurative otitis media (CSOM) without
cholesteatoma ( tubo-tympanic variety)
3. Chronic suppurative otitis media (CSOM) with
cholesteatoma ( Attico- Antral variety)
4. Chronic Adhesive otitis media.
5. Chronic specific otitis media, TB, Syphilis.
CSOM- Chronic Suppurative Otitis Media

Definition:

It is the chronic inflammatory process by pyogenic


organism involving the middle ear cleft producing
irreversible pathological changes.
(lasting for more than 3 month)
• Type:
• 1. Tubotympanic or Safe.
• 2. Atticoantral or Unsafe.
CSOM- Chronic Suppurative Otitis Media

Aetiology:
Sequlae of ASOM due to
- Inadequate treatment of ASOM,
-Virulence of organism,
-Immunosupressed Patient,
Repeated entry of infection through perforation in middle ear
(dirty water)
Repeated infection of RT reaching middle ear through E.
tube
Infection from sources; sinus ,nasophraynx Adenoid,Tonsil,
Tuberculosis,
Persistent traumatic rupture of TM,
Grommet insertion.
CSOM- Chronic Suppurative Otitis Media(cont.)
Organisms:
Pseudomonas aeruginosa.
Proteus.
E. coli.
Staphylococcus.
Streptococcus.
Anaerobic:- Bacteroides fragalis.
Anaerobic Streptococcus.
CSOM- Chronic Suppurative Otitis Media(cont.)

Pathology;

The middle ear mucosa becomes oedematous and


velvety; the pavement cells become secreting columner
cells (goblet cells) due to metaplasia or extention of the
mucosa from the E. tube.

Same pathological changes also occur in the mastoid


air cells.
CSOM- Chronic Suppurative Otitis Media(cont.)

Criteria of CSOM:
•Loss of hearing,
•Discharge from ear ,
•Perforation of Tm.

Loss of hearing:
Mild conductive type of hearing loss- Small perforation
Moderate conductive type of hearing loss – Largeperforation
Sensory neural hearing loss - when Cochlea is affected in
Long standing case.
CSOM- Chronic Suppurative Otitis Media(cont.)

Discharge from ear:


Intermittent.
Mucoid.
Mucopurulent
Usually no foul smell- but when infection by .
pseudomonas or proteus may have bad smell.
Profuse discharge when associated with URTI.
CSOM- Chronic Suppurative Otitis Media(cont.)

Perforation

Central-
Small.
Large.
Subtotal.
CSOM- Chronic Suppurative Otitis Media(cont.)

Investigations:
•P T A
•Pus for c/s
•X-ray mastoid.
•X-ray PNS
•CT scan
CSOM- Chronic Suppurative Otitis Media(cont.)

Complications:
Minor
- mucosal polyp
-Granulation tissue formation
Major
- Extra cranial.
and
-Intra cranial.
CSOM- Chronic Suppurative Otitis Media(cont.)

Aims of treatment:

•To eliminate the disease

•To repair the perforation.

•To control the disease


CSOM- Chronic Suppurative Otitis Media(cont.)

Treatment:
1. Aural toileting,
2. Ear drops,
3. Systemic antibiotics,
4. Precautions,
5. Treatment of contributory factors,
6. Surgical treatment-tympanoplasty.
CSOM- Chronic Suppurative Otitis Media(cont.)

TYMPANOPLASTY
Prerequisites of Tympanoplasty -

1.Ear should be dry at least for 6 weeks.

2. E. tube should be functioning .

3. There must be enough cochlear reserve .

4. There should be no contributory factors..


CSOM- Chronic Suppurative Otitis Media(cont.)

Advantages of Tympanoplasty
•To make the ear dry by preventing further
infection in the ear.
•To improve hearing & to prevent further
deteriorating of hearing.
• To prevent complication.
•For using hearing aid.
•To enable recruitment in certain profession.
CSOM- Chronic Suppurative Otitis Media(cont.)

IS TYMPANOPLASTY DONE IN BANGLADESH?

CAN IT BE DONE BY LOCAL ANESTHASIA?

WHAT IS USED AS GRAFT AS MATERIAL?

IS IT A COSTLY OPERATION?

IS IT A RISKY OPERATION?

DOES IT REQUIRE LONG HOSPITAL STAY?

DOES THIS OPERATION HAVE MANY COMPLICATIONS?

WHAT TYPE OF SURGERY IS IT?


WHAT IS THE SUCCESS RATE OF THIS SURGERY?

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