2. DEFINITION
CSOM is a long standing infection of a
part or whole of middle ear cleft
characterised by ear discharge and
permanent perforation.
3. EPIDEMIOLOGY
Higher in developing countries
- poor socioeconomic standards
- poor nutrition
- lack of health education
Affects both sexes
All age groups
4. TYPES
Tubotympanic Atticoantral
Discharge Profuse, mucoid, Scanty, Purulent,
odourless foul smelling
Perforation Central Attic or Marginal
Polyp Pale Red and fleshy
Cholesteatoma Absent Present
Granulations Uncommon Common
Complications Rare Common
Audiogram Mild CD CD or Mixed
5. TUBOTYMPANIC
Aetiology
Sequela of acute otitis media
Ascending infections via eustachian tube from
infected tonsils, adenoids, infected sinuses
Allergy to ingestants such as milk, egg,fish etc.
6. PATHOLOGICAL CHANGES
1. Perforation of Pars tensa
central perforation
2. Middle ear mucosa
inactive – normal
active – oedematous and velvety
7. 3. Polyp
smooth mass of oedematous and
inflammed mucosa ; pale
4. Ossicular chain
intact and mobile
necrosis of long process of incus
8. 5. Tympanosclerosis
hyalinisation and calcification of
subepithelial conn. tissue.
white chalky deposits on
ossicles, promontory, joints, tendons, ov
al window and round window.
6. Fibrosis and adhesions
due to healing process
10. CLINICAL FEATURES
1. Ear discharge
Non offensive, mucoid or mucopurulent.
Constant or intermittent.
2. Perforation
Central - anterior, posterior or inferior to
handle of malleus.
Small, medium or large.
11. 3. Hearing loss
Conductive
Round window shielding effect
Hears better in the presence of
discharge than dry ear.
Long standing cases – mixed type
4. Middle ear mucosa
Pale pink and moist – normal
Red oedematous and swollen - inflammed
12. INVESTIGATIONS
1. Examination under microscope
Granulations
Status of ossicular chain
Ingrowth of sq epithelium from edges
of perforation
Tympanosclerosis
Adhesions
13. 2. Audiogram
Conductive hearing loss
3. Culture and sensitivity of ear discharge
Select proper antibiotic ear drops
4. Mastoid X-rays
Usually sclerotic but may be
pneumatised with clouding of air cells
No bone destruction