Download - CSOM TUBO TYMPANIC DISEASE
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CSOM - TUBOTYMPANIC
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DEFINITION
CSOM is a long standing infection of a part or whole of middle ear cleft characterised by ear discharge and permanent perforation.
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EPIDEMIOLOGYHigher in developing countries
- poor socioeconomic standards- poor nutrition- lack of health education
Affects both sexes
All age groups
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TYPES Tubotympanic
Atticoantral
Discharge Profuse, mucoid, Scanty, Purulent,
odourless foul smellingPerforation Central Attic or MarginalPolyp Pale Red and fleshyCholesteatoma Absent PresentGranulations UncommonCommonComplications Rare CommonAudiogram Mild CD CD or Mixed
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TUBOTYMPANIC Aetiology
Sequela of acute otitis mediaAscending infections via eustachian tube from infected tonsils, adenoids, infected sinusesAllergy to ingestants such as milk, egg,fish etc.
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PATHOLOGICAL CHANGES
1. Perforation of Pars tensa central perforation
2. Middle ear mucosa inactive – normal active – oedematous and velvety
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3. Polyp smooth mass of oedematous
and inflammed mucosa ; pale
4. Ossicular chain
intact and mobile necrosis of long process of
incus
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5. Tympanosclerosis hyalinisation and calcification
of subepithelial conn. tissue. white chalky deposits on
ossicles, promontory, joints, tendons, oval window and round window.
6. Fibrosis and adhesions due to healing process
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BACTERIOLOGY
Aerobic Ps. aeruginosa Proteus E coli Staph aureusAnaerobic Bact. fragilis Anaerobic streptococci
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CLINICAL FEATURES
1. Ear discharge Non offensive, mucoid or mucopurulent.Constant or intermittent.
2. PerforationCentral - anterior, posterior or inferior to handle of malleus.Small, medium or large.
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3. Hearing lossConductive Round window shielding effectHears better in the presence of
discharge than dry ear.Long standing cases – mixed type
4. Middle ear mucosaPale pink and moist – normal
Red oedematous and swollen - inflammed
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INVESTIGATIONS1.Examination under microscope
Granulations Status of ossicular chain Ingrowth of sq epithelium from
edges of perforation
Tympanosclerosis Adhesions
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2. AudiogramConductive hearing loss
3. Culture and sensitivity of ear discharge
Select proper antibiotic ear drops
4. Mastoid X-raysUsually sclerotic but may be pneumatised with clouding of air cellsNo bone destruction
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TREATMENT
Aim to control infectioneliminate ear dischargecorrect hearing loss
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1. Aural toilet
- remove discharge and debris from ear dry mopping with absorbent cotton
buds suction clearance under microscope irrigation with sterile NS
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2. Ear drops Neomycin, Polymyxin, Chloromycetin, Gentamycin Steroids
3. Systemic antibioticsa/c exacerbation of c/c infected ear
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4. Precautionskeep water out of earhard nose blowing avoided
5. Treatment of contributory cause
infected tonsils, adenoids, nasal allergy
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6. Surgical treatmentaural polyps and granulations if
present
7. Reconstructive surgerymyringoplasty
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