3. Chronic Otitis media - types. Clinical complications. Traumatic rupture of the tympanic membrane.

Question 1

What is Chronic OM?

Answer 1

• Otitis Media which lasts for MORE THAN 3 months - considered CHRONIC
• Affects CHILDREN MORE&raquo_space; Adults

Question 2

What are the Causes if Chronic OM?

Answer 2

2 Functional Disturbances
- IMPAIRED Middle Ear Ventilation
- Inflammation

CAUSING PERMANENT Damage, BUT with LESS SEVERE Symptoms

Question 3

What are the TYPES / SUBTYPES of Chronic OM?

Answer 3

1) Chronic Non-Specific OM
- chronic suppurative OM (CSOM)
- chronic non-suppurative OM (CNSOM)

2) Chronic Specific OM
- Active : Safe / Unsafe
- Inactive : AFTER CSOM / Adhesive Otitis Media

Question 4

What is Chronic SUPPURATIVE Otitis Media? (CSOM)

Answer 4

• Type of NON-Specific OM
• Lasts from 6 Weeks - 3 Months OR MORE
• Essentially Chronic OM, but with RECURRENT Ear Discharge WITH Tympanic Membrane PERFORATION

Question 5

What is the CLASSIFICATION of Chronic SUPPURATIVE Otitis Media? (CSOM)

Answer 5

1) TUBOTYMPANIC DISEASE
- Non-Cholesteatomatus
- SAFE Chronic Suppurative OM

2) ATTICO-ANTRAL DISEASE
- Tympanomastoid Chronic Suppurative OM
- UNSAFE Chronic Suppurative OM

Question 6

What is TUBOTYMPANIC DISEASE (Chronic Suppurative OM)?

Answer 6

• SAFE Disease, due to it’s LACK of SERIOUS Complications
• Where Infx is LIMITED TO Mucosa AND Antero-Inferior Part of MIDDLE EAR CLEFT
• Route Of Infx = FROM Eustachian Tube WITH UNDERLYING INFX from Nose / Sinus / Nasopharynx
• MAINLY CAUSED = P.Aeuroginosa Bacterium

Question 7

What is the DIAGNOSIS for TUBOTYMPANIC DISEASE?

Answer 7

CHECK FOR:
- PREVIOUS Surgery SCARS
- Discharge

EXAMINE
- OTOSCOPE = Size + Site of Perforation
- Nose & Throat
- Eustachian Tube Function

HEARING TEST
- Level of Hearing
- Speech Threshold

RADIOGRAM = Cases of CHOLESTEATOMATUS

CT = Suspecting COMPLICATIONS of Intracranial OR Intratemporal

Question 8

What is the TREATMENT for TUBOTYMPANIC DISEASE?

Answer 8

• Draining
• Antibiotics

** Surgery = IF EVERYTHING ELSE IS A FLOP!!!

Question 9

What is ATTICO-ANTRAL DISEASE? (Chronic Suppurative OM)?

Answer 9

• UNSAFE Disease, due to INTRA / EXTRA-CRANIAL COMPLICATIONS
• Where disease SPREADS VIA EROSION of BONY WALLS of ATTIC
• Common Case of CHOLESTEATOMA

Question 10

What is CHOLESTEATOMA?

Answer 10

• CYSTIC BAG Structure
• Lined by STRATIFIED SQUAMOUS Epithelium
• Found in ATTIC Region
• DESTROYED Bone
• Either WITH / WITHOUT Infection and Discharge

Question 11

What are the TYPES of CHOLESTEATOMA?

Answer 11

1) CONGENITAL

2) ACQUIRED = Primary / Secondary

a) Primary
- NO Previous Hx of Otits
- Lesion FROM ATTIC Region

• Eustachian Tube DYSFUNCTION = Causing RETRACTION of PARS FLACCIDA, which DESTROYS Attic WALLS

a) Secondary
- AFTER Active OM
- PERFORATION in PARS TENSA
- RETRACTION in PARS TENSA

Question 12

What are the COMPLICATIONS of Chronic OM?

Answer 12

• Hearing Loss
• INTRACRANIAL Cx = Mental Status Changes / Abscess / Emphysema / Meningitis
• FACIAL PARALYSIS = Depending on which Nerve, BUT MOST COMMON at Geniculate Ganglion, DUE to DISEASE at ANTERIOR EPITYMPANUM

Question 13

Describe TYMPANIC MEMBRANE TRAUMA

{Including Symptoms, Diagnosis & Treatment}

Answer 13

Either Direct / Indirect

Direct = Sharp Objects / Swabs

Indirect = Pressure Changes (Barotrauma) / Ear Slaps / Diving - where OUTSIDE pa&raquo_space;> Inside TC

Symptoms = Pain / Bleeding / Clogged Sensation

Diagnosis = Otoscopy / Hearing Test

Treatment = Heal ITSELF!!!