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Types of Otitis MediaByProf. Haseeb Ahmed Bhatti2008-98

OTITIS MEDIA DEFINITIONOtitis Media is the Inflammation of part or all of the lining mucosa of the middle ear cleft i.e the eustachian tube, tympanic cavity, attic, aditus, antrum and mastoid air cells.

CLASSIFICATION of OTITIS MEDIAOtitis media is a broad subject which could be classified according to:(1) Duration(2) Nature of fluid/discharge : Suppurative & Non-Suppurative.(3)Otitis media with effusion and Aero-otitis media(4) Causative organism- bacterial otitis media (common) and specific otitis mediae.g. Tubercular and syphilitic otitis media(less common).

Classification of Otitis Media(according to the duration of illness)ACUTERapid Onset Of symptoms,3 months duration)inflammation of the muco-periosteallining of the Middle Ear cleft

OTITIS MEDIAAcuteASOM/AOMSubacute Chronic CSOMTubotympanic(Mucosal disease) Atticoantral(Cholesteatoma) Active mucosal diseaseInactive disease

Diff B/w types of CSOMTubotympanicSafe typeAtticoAntralUnSafe typeDischargeProfuse, mucoid, odourlesScanty, Purulent, Foul-smellingPerforationCentralAttic or MarginalGranulationUncommonCommonPolypPaleRed & FleshyCholesteatomaAbsentPresentComplicationsRareCommonAudiogramMild to Moderate Conductive deafnessConductive or Mixed deafness

CSOM TubotympanicTypes & PathologyTypesActive :when the ear is actively dischargingInactive :when the ear is dry

PathologyPerforation is almost always centralMucosa is inflammed, edematousPolyps may be seenOssicular chain is usually intactMastoid is usually cellular

Tubotympanic CSOMMicrobiologyPseudomonas AeroginosaProteusE. ColiPneumococciStreptococciStaphylococcus

TREATMENT OPTIONS Suction clearance.Avoidance of water.Treat primary cause in U/LRT.Antibiotics Systemic and Topical.Surgical disease clearance -Mastoidectomy.TympanoplastyClosure of TM defect - MyringoplastyReconstruction of ossicles Ossiculoplaty

Attico-antraltype of CSOMCSOM with Cholesteatoma

This type of C.S.O.M. is considered as dangerous / unsafe type.

This type of CSOM is associated with formation of Cholesteatoma, granulation tissues & occasionally cholesterol granulomas.

If left untreated, it leads to serious complications involving the temporal bone and cranial cavity & brain.

What is a Cholesteatoma ?Cholesteatoma is simply skin in wrong placeAural cholesteatoma is a bag of Stratifiedsquamous epithelium within the middle ear which contains desquamated epithelial debris (mainly keratin) and germs.(This term is a misnomer: it is neither a tumor nor it contains cholesterol crystalsThe correct term : a Keratoma.

POLYPCholesteatoma

SYMPTOMS

Investigations Aural swabEar discharge can be taken for C/S.X-ray mastoidsAudiometry (hearing test) CT scanMRI

TREATMENTSurgicalCanal wall up Simple or Combined Approach TympanoplastyCanal wall downRadical Mastoidectom, Modified radical Mastoidectomy, Atticotomy.ReconstructiveMyringoplastyTympanoplasty

TUBERCULAR OTITIS MEDIA

PATHOLOGY (Slow & Insidius)

CLINICAL FEATURES

DIAGNOSISTREATMENTCulture, Histopathology, CxrayATT, Ear toilet/prevention, Surgery

SYPHILITIC OTITIS MEDIA

MANAGEMENTHistory & complete ENT examinationProbable diagnosisInvestigationsDefinite diagnosisAntisyphilitic treatmentAural toiletControl of secondary infectionSurgery for removal of sequestra

So,At the End of the Presentation our objective was.

TYPES OF OTITIS MEDIAACUTEAcute otitis media widout effusionAcute otitis media with effusionAero otitis media

CHRONICChronic suppurative otitis media(TT&AA)Tuberculous otitis mediaSyphilitic otitis media

Haseeb Ahmed Bhatti