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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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