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PROFESSOR OF OTOLARYNGOLOGY

UNIVERSITY OF ALEXANDRIA

PROFESSOR OF OTOLARYNGOLOGY

UNIVERSITY OF ALEXANDRIA

Chronic Suppurative Otitis Media

Chronic Suppurative Otitis Media

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Inflammatory changes of the mucoperiosteallining of the middle ear cleft of insidious onset and protracted course, characterized by development of irreversible tissue pathology.

Inflammatory changes of the mucoperiosteallining of the middle ear cleft of insidious onset and protracted course, characterized by development of irreversible tissue pathology.

DefinitionDefinition

Chronic Suppurative Otitis MediaChronic Suppurative Otitis Media

Classification

Tubo-tympanic type(Safe type)

Attico-antral type(Unsafe type)

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Chronic Otitis Media(Tubo-tympanic type)

Tubo-tympanic disease

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Attico-antral Disease

Chronic Suppurative Otitis Media

Chronic Suppurative Otitis Media

• Safe Type (Tubo-tympanic)• Unsafe Type (Attico-antral)

Cholesteatoma

• Safe Type (Tubo-tympanic)• Unsafe Type (Attico-antral)

Cholesteatoma

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SymptomsSymptoms

• OtorrhoeaMuco-purulent, odourless, profuse and intermittent.

• DeafnessMild to moderate; conductive HL.

• OtorrhoeaMuco-purulent, odourless, profuse and intermittent.

• DeafnessMild to moderate; conductive HL.

OtoscopyOtoscopy

• PerforationCentral, in pars tensa.

• Cholesteatoma/granulationsAbsent.

• PerforationCentral, in pars tensa.

• Cholesteatoma/granulationsAbsent.

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InvestigationsInvestigations

• X rays– Cellular mastoid.

• C&S– Gram +ve organisms.

• X rays– Cellular mastoid.

• C&S– Gram +ve organisms.

TreatmentTreatment

• Medical Treatment Antibiotherapy according to C&S.

• Chemical cautery of perforation margins.• Myringoplasty.• Tympanoplasty

Myringoplasty+ossiculoplasty

• Medical Treatment Antibiotherapy according to C&S.

• Chemical cautery of perforation margins.• Myringoplasty.• Tympanoplasty

Myringoplasty+ossiculoplasty

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Chronic Suppurative Otitis Media

Chronic Suppurative Otitis Media

• Safe Type (Tubo-tympanic)• Unsafe Type (Attico-antral)

Cholesteatoma

• Safe Type (Tubo-tympanic)• Unsafe Type (Attico-antral)

Cholesteatoma

CHOLESTEATOMACHOLESTEATOMA

Definition:Cholesteatoma is a destructive

and expanding keratinizing squamous epithelium in the middle ear and/or mastoid process.

Definition:Cholesteatoma is a destructive

and expanding keratinizing squamous epithelium in the middle ear and/or mastoid process.

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How can the skin reach the middle ear?How can the skin reach the middle ear?• Congenital• Retraction of the drum

(Retraction pocket)• Migration through a

marginal perforation

• Congenital• Retraction of the drum

(Retraction pocket)• Migration through a

marginal perforation

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SymptomsSymptoms

• Otorrhoeapurulent, foetid, scanty and continuous.

• DeafnessModerate to severe; conductive or mixed.

• Otorrhoeapurulent, foetid, scanty and continuous.

• DeafnessModerate to severe; conductive or mixed.

Chronic Otitis MediaChronic Otitis Media

Is not a painful conditionIs not a painful condition

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OtoscopyOtoscopy• Perforation

Attic, or marginal (usually posterosuperior).

• GranulationsCommon, red and fleshy,usually posterosuperior.

• CholesteatomaAttic or posterosuperior.

• PerforationAttic, or marginal (usually posterosuperior).

• GranulationsCommon, red and fleshy,usually posterosuperior.

• CholesteatomaAttic or posterosuperior.

InvestigationsInvestigations

• XraysAcellular mastoid, filling defect (cholesteatoma

shadow).• C&S

Gram -ve organisms.

• XraysAcellular mastoid, filling defect (cholesteatoma

shadow).• C&S

Gram -ve organisms.

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TreatmentAlways surgical

TreatmentAlways surgical

Tympano-mastoidectomy = Tympanoplasy+mastoidectomy

Tympano-mastoidectomy = Tympanoplasy+mastoidectomy

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