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Chronic Otitis Media

Chronic Otitis Media. Bastaninejad Shahin , MD, ORL & HNS. COM with Cholesteatoma. COM with Cholesteatoma. Epidermal inclusion cyst of the ME or Mastoid cavity Classification: Congenital (usually Ante.Sup.): appear behind or within an intact TM Acquired (usually Post.Sup.):

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Chronic Otitis Media

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  1. Chronic Otitis Media BastaninejadShahin, MD, ORL & HNS

  2. COM with Cholesteatoma

  3. COM with Cholesteatoma • Epidermal inclusion cyst of the ME or Mastoid cavity • Classification: • Congenital (usually Ante.Sup.): appear behind or within an intact TM • Acquired (usually Post.Sup.): • Otorrhea often malodorous (Mixed>Anaerobes>Aerobes  1 bacteroides, 2 Pseudomonas,...) • Keratin debris in the center of the perforation • Acute flare up may resemble AEO • Vertigo, hearing loss, Facial nerve paralysis,...

  4. Pathogenesis • Congenital: originates from areas of keratinizing epithelium within a small area in the Anterior tympanum • Acquired: • Invagination (ex vacuo theory – in OME or eustachian dysfunction) • Basal cell hyperplasia • Epithelial ingrowth • Squamous metaplasia * *Retraction pocket Cholesteatoma (Sundhoff & Tos)

  5. Complications • Hearing loss through: perforation, ossicular erosion (mainly incus), otic capsule erosions (mainly LSCC, labyrinthine fistula may be found in up to 10% of the cases) • Facial nerve paralysis (acute/chronic) • Tegmen erosion  brain hernia or CSF leakage,... • Intracranial infections

  6. Management • Surgical (see next slide for anatomy) • Canal wall down (CWD) • Advantage: recurrence is low • Disadvantage: mastoid cavity problem • Canal wall up (CWU) • Adv.: physiologic position of TM, no mastoid cavity problem • Disadv.: recurrence is high, often nedd second stage exploration

  7. Anatomy outlines

  8. COM without Choles.

  9. COM without Choles. • Permanent perforation of the TM with or without recurrent infection • Hearing loss regarding to the perforation size: • Small perforation: Low Freq. Air Bone GAP • Large Perforation: Low+High freq. ABG • Bacteriology: usually Mixed>Aerobes>Anaerobes

  10. Differentiate traumatic TM perforation with COM

  11. Management • Medical (mainly topical, in refractory infections use systemic therapy with  Ciprofloxacin,...) • Surgery: • Tympanoplasty (dry perforation, less than 25dB ABG) • Tympanomastoidectomy (several episodes of otorrhea, more than 25dB ABG)

  12. Tympanosclerosis

  13. Tympanosclerosis • Acellular hyalin and calcified deposits accumulate within the TM and ME submucosa • Pathogenesis: • Consequence of resolved otitis media of trauma • Ossicular fixation may occure (most frequently in the attic  head of the malleus and incus)

  14. Management • Management is like COM without cholesteatoma, But ossicular fixation must be corrected simultaneously (except stapedius fixation)

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