Chronic suppurative otitis media | CSOM | ENT | MEDVIDSMADESIMPLE

Summary

This educational video delves into chronic suppurative otitis media, a persistent middle ear infection with ear discharge and a permanent tympanic membrane perforation. It highlights two types: the safe tubotympanic and the dangerous atticoantral, discussing their causes, symptoms, and treatments. The video also explains unique phenomena like the round window shielding effect and the formation of retraction pockets, emphasizing the importance of understanding these conditions for effective patient care.

Takeaways

• 👂 Chronic suppurative otitis media (CSOM) is characterized by a long-standing middle ear infection with ear discharge and permanent perforation of the tympanic membrane.
• 🔍 The edges of the tympanic membrane perforation in CSOM are covered by squamous epithelium, preventing natural closure.
• 📚 There are two main types of CSOM: tubotympanic (safe and benign) and atticoantral (associated with complications like cholesteatoma).
• 🌐 Tubotympanic type is usually not associated with complications and involves the anterior inferior part of the middle ear cleft, often resulting in profuse ear discharge.
• 🌟 Atticoantral disease involves the posterior superior part of the middle ear cleft and is associated with scanty discharge and potential complications.
• 👨‍⚕️ CSOM can result from untreated acute otitis media or ascending infections through the eustachian tube, often due to recurrent upper respiratory tract infections or pharyngitis.
• 🔍 In tubotympanic CSOM, the middle ear mucosa is red, congested, and edematous, sometimes with polyp formation, while the ossicles are usually normal.
• 👂 The 'round window shielding effect' in tubotympanic CSOM improves hearing due to ear discharge maintaining a phase differential, which can worsen hearing if the discharge is drained.
• 🩺 Diagnosis involves otoscopy, examination under microscopy, audiometry, and culture and sensitivity tests of ear discharge, with imaging like mastoid X-rays or CT scans to assess bone destruction.
• 🛠️ Treatment aims to control infection and ear discharge, with ear cleaning, antibiotics, and addressing underlying causes like adenoid inflammation. Surgical intervention may be necessary for reconstruction and correction of perforations.

Q & A

What is chronic suppurative otitis media?

Chronic suppurative otitis media is a condition characterized by a long-standing middle ear infection associated with ear discharge and permanent perforation of the tympanic membrane.

Why is the tympanic membrane perforation considered permanent in chronic suppurative otitis media?

The tympanic membrane perforation is permanent in chronic suppurative otitis media because the edges of the perforation are covered by squamous epithelium, which prevents a natural closure of the perforation.

What are the two types of chronic suppurative otitis media mentioned in the script?

The two types of chronic suppurative otitis media mentioned are tubotympanic (safe or benign type) and atticoantral (unsafe or dangerous type).

Why is the tubotympanic type of chronic suppurative otitis media considered safe or benign?

The tubotympanic type is considered safe or benign because it is usually not associated with many complications.

What is the significance of the central perforation in the tympanic membrane in tubotympanic disease?

Central perforation in the tympanic membrane is significant in tubotympanic disease as it is usually safe and associated with profuse ear discharge due to the infection of the anterior inferior part of the middle ear cleft, which is lined by ciliated columnar epithelium.

How can chronic suppurative otitis media develop?

Chronic suppurative otitis media can develop as a sequelae of acute otitis media that is not treated properly or as a result of ascending infections where infected secretions from recurrent upper respiratory tract infections or pharyngitis reach the middle ear cavity through the eustachian tube.

What is the round window shielding effect in tubotympanic disease?

The round window shielding effect is a phenomenon in tubotympanic disease where the ear discharge improves hearing by maintaining the phase differential, acting as a shield over the round window, allowing sound waves to be conducted normally.

What are the common pathogens involved in tubotympanic disease?

The common pathogens involved in tubotympanic disease include Pseudomonas aeruginosa, Proteus ecoli, staph aureus, Bacteroides fragilis, and anaerobic streptococci.

What are the clinical features of tubotympanic disease?

The clinical features of tubotympanic disease include profuse, non foul-smelling mucoid or mucopurulent ear discharge, conductive hearing loss, and central perforation in the pars tensa of the tympanic membrane.

What are the treatment aims and methods for chronic suppurative otitis media?

The treatment aims for chronic suppurative otitis media are to control the infection and ear discharge, and to correct hearing loss. Methods include ear cleaning (aural toilet), ear drops, systemic antibiotics, addressing underlying causes like adenoidectomy in pediatric patients, and reconstructive surgery like tympanoplasty.

What is cholesteatoma and how is it related to atticoantral disease?

Cholesteatoma is a condition where keratinized squamous epithelium is present in the middle ear cavity, which is not its normal location. It is associated with various complications and is a common feature in atticoantral disease, often leading to bone erosion and hearing loss.