CHRONIC SUPPURATIVE OTITIS MEDIA TUBOTYMPANIC TYPE Dr Sharwak

CHRONIC SUPPURATIVE OTITIS MEDIA TUBOTYMPANIC TYPE Dr. Sharwak Ramlan

Chronic suppurative otitis media is a chronic inflammation of middle ear cleft characterized by ear discharge and perforation in the tympanic membrane Types 1. Tubo tympanic type 2. Atticoantral type

Tubotympanic type Safe or benign type Involves anterior inferior part of middle ear cleft, associated with central perforation

Aetiology As sequelae of Acute otitis media Ascending infections via Eustachian tube, that is the infection from tonsils, adenoid, sinuses Persistent mucoid otorrhea is sometimes result of allergy to ingestants such as milk, egg, fish

Pathology 1. Perforation in pars tensa: it is a central perforation Small central perforation Medium central perforation Large central perforation Subtotal perforation

2. middle ear mucosa is oedematous and velvety when the disease is active 3. polyp: smooth mass of oedematous and inflamed mucosa which is protruded through the perforation, usually pale 4. ossicular chain: sometimes there may some degree of necrosis of long process of incus 5. tympanosclerosis is seen in remnants of tympanic membrane or under mucosa of middle ear 6. fibrosis and adhesions: further impairs mobility of ossicular chain or block eustachian tube

Bacteriology Aerobic: pseudomonas aeruginosa, proteus, E. coli, staph aureus Anaerobic: bacteriodes fragilis, anaerobic streptococci Mixed infection

Clinical features Symptoms: eardischarge: profuse, mucoid, odourless, intermittent Reduced hearing

On examination: Perforation-small, medium, large central perforation or subtotal perforation Middle ear mucosa: normally it is pale pink and moist, active stage it is red, oedematous, inflamed

Management Investigation: Examination under microscope Culture and sensitivity of ear discharge Pure tone audiometry Mastoid x-ray/CT scan temporal bone Look for source of infection: X-ray PNS-chronic sinusitis X ray soft tissue neck lateral view: adenoid hypertrophy

Treatment Active stage: Aural toilet by dry mopping and suctioning Ear drops based on C&S Systemic antibiotics Surgery: adenotonsillectomy for adenoid hypertrophy and chronic tonsillitis FESS for chronic sinusitis Patient is advised to keep water out of the ear during bathing, swimming, hair wash

Inactive stage Tympanoplasty: Eradication of disease of middle ear with osssicular chain reconstruction with or without repair of perforation in tympanic membrane

Sequelae Tympanosclerosis Tympanic membrane perforation Conductive hearing loss Speech impairment Learning disability