Chronic suppurative otitis media (CSOM) Flashcards

1
Q

What are the complications of otitis media (not just CSOM)?

A

ntracranial

  • Meningitis
  • Extradural/intracranial abscess
  • Sigmoid sinus thrombosis (because sigmoid sinus is near the mastoid)

Extracranial (more superficial infx): intratemporal VS extratemporal

Intratemporal cx (2’ bone erosion/thrombophlebitis of communicating vessels)

  • TM perforation
  • Tympanosclerosis (thickening of TM)
  • Petrositis (involvement of petrous bone; note that CN V and VI may be affected)
  • If infection spreads to the petrous apex (more medial), can cause Gradenigo syndrome [triad of retro/peri-orbital pain (CN5 involvement) + diplopia (CN6 palsy) + otorrhoea]
  • Facial nerve palsy (CN7 palsy)
  • Labyrinthitis (CN8): Represents spread of middle ear infection to inner ear
  • Labyrinthine fistula -> note that fistulas are complications of a chronic process (CSOM) and not an acute process -> when a perforation epithelializes, it becomes a fistula which does not heal

Extratemporal cx
- Mastoiditis +/- mastoid sub-peri

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2
Q

What is the definition of CSOM?

A

Chronic inflammation (> 6 wks) of the middle ear a/w non-healing TM perf;

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3
Q

What is the pathophysiology of CSOM?

A
  • Usually in children due to prolonged/recurrent AOM that is inadequately treated -> TM perf epithelializes and becomes a non-healing fistula forever
  • May be iatrogenic from myringotomy or grommet tube insertion
  • Fistula where tract is lined by mucosal epithelium (from middle ear) – prevents tract closure
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4
Q

What is central CSOM?

A

360 deg remnant eardrum surrounding it

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5
Q

What is marginal CSOM?

A

on margins, don’t have 360 deg remnant eardrum

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6
Q

What are the clinical features of CSOM?

A

Otorrhoea: intermittent, watery-mucoid/mucopurulent (if a/w infection)

CHL

  • Mild (10-20dB) if only TM is damaged
  • Severe (50-70dB) if ossicular chain is damaged (usually the incus)

Hard to differentiate AOM w/ perforation from CSOM on otoscopy -> Hx impt (especially duration, hx is the only distinguishing point)

Otoscope: can present a thickened TM due to fibrosis and inflammation -> resulting in a featureless TM (lacking bony structures and translucency)

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7
Q

What are the investigations of CSOM?

A
  • Definitive diagnosis on otoscopy
  • Consider PTA, tympanometry, swabs, vestibular assessment w/ fistula test, CT of temporal bones (aid surgical management), MRI (to delineate intra-cranial complications)
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8
Q

What is the management of CSOM?

A

Medical

  • Regular aural toilet (drain pus – can be painful); keep ear dry (KED) to settle active infx
  • If infected, give topical abx since TM has perforated and topical antibiotic can reach site of infection).
  • Drugs tend to enter the inner ear via the oval window (where the footplate of the stapes lies)

Surgical i.e. tympanoplasty/myringoplasty (definitive treatment)
- Indications for sx: recurrent infection (absolute indication),. improve QOL/not keen on water precautions (e.g. in water sports athletes where it is difficult to KED without intact TM)

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9
Q

What are the complications of otitis media (not just CSOM)?

A

Intracranial

  • Meningitis
  • Extradural/intracranial abscess
  • Sigmoid sinus thrombosis (because sigmoid sinus is near the mastoid)

Extracranial (more superficial infx): intratemporal VS extratemporal

Intratemporal cx (2’ bone erosion/thrombophlebitis of communicating vessels)

  • TM perforation
  • Tympanosclerosis (thickening of TM)
  • Petrositis (involvement of petrous bone; note that CN V and VI may be affected)
  • If infection spreads to the petrous apex (more medial), can cause Gradenigo syndrome [triad of retro/peri-orbital pain (CN5 involvement) + diplopia (CN6 palsy) + otorrhoea]
  • Facial nerve palsy (CN7 palsy)
  • Labyrinthitis (CN8): Represents spread of middle ear infection to inner ear
  • Labyrinthine fistula -> note that fistulas are complications of a chronic process (CSOM) and not an acute process -> when a perforation epithelializes, it becomes a fistula which does not heal

Extratemporal cx
- Mastoiditis +/- mastoid sub-peri

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