CSOM 4 ppt Dr Javed shah FRCS Bannu Medical college

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Chronic supporative otitis media: 

Chronic supporative otitis media

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C SOM is an infection of middle ear space associated with irreversible tissue disease. This entity is clinically seen as ME infection associated with non healing perforation(TYPES) of TM

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Etiology 1/socioeconomic group 2/Genetics: Race,mastoid air cell. 3/Previous:AOM,OME. 4/Infective

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5/URTI viral, sinusitis 6/ Allergy. hay fever. sensitivity to antibiotic ear drops. 7/ Eustachian tube malfunction.

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Classification of CSOM . 1/ Tubotympanic 2/ Atticoantral

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Tubotympanic: Disease of anterior part of ME and associated with non healing central perforation

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Pathology : localised to ME mucosa. Active, quiescent or inactive 1/perforation of TM, central and non healing. 2/Middle ear mucosa: edematous or inactive

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3/Aural polyp 4/ Tympanosclerosis 5/ adhesions

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Bacteriology : Aerobes: Ps aeroginosa,Proteus Anaerobes: Bacteroids

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Clinical Features :1/ Ear discharge 2/ Hearing loss: conductive, Perforation, role of round window, baffle effect

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3/Perforation: small,medium,large 4/ Middle ear mucosa and formation of polyp.

CSOM( TT): 

CSOM( TT)

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Investigation: 1/ Examination under Microscope 2/ swab for C/S 3/Hearing test 4/CT Scan?

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Treatment: Aural toilet Ear drops. gentisone HC ear drops, lying and prssure on tragus.1.5% acetic acid ear drops( pseudomonas acid ph nasal allergy,infected tonsils, sinusitis

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Surgical Treatment, aural polyp, Dry perforation Myringoplasty

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Atticoantral: Csom affecting Posterosuperior part of P/T, attic,antrum, and mastoid. Causes bone erosion.. high risk of complications.

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Pathology:1/ how the retraction pocket forms ,role of OME. 2/Role of keratinized squamous epithelium 3/ bone erosion, proteolytic enzymes,

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3/ Osteitis: granulations,leads to bleeding and fleshy polyp. 4/ cholesterol granuloma. cholesterol from blood and giant cell grnuloma

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Presentation in the clinic: 1/ Ear discharge, scanty and foul smelling

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2/ Hearing loss; may be normal erosion of incudostapedial joint conductive deafness sensorineural +conductive (mixed)

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blood stained discharge ..granulations or polyp

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Signs : otoscope (clean the ear) attic or postero superior. crusting and small wax in attic may be masked.

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Retraction pocket

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Choleatetoma white flakes of squamous epithelium in retraction pouch

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investigation: Examination under microscope for assessment swab for c/s CT scan Mastoid

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Surgery : remove the disease and second to reconstruct the ossicular assembly

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Mastoidectomy 1/ canal wall down: Radical(all ossicles removed) modified radical(ossicles saved) 2/ canal wall up; combined approach ....

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Conservative management, if limited disease or very old age . suction clearance under microscope