"Chronic Otitis Media: Understanding Squamousal Type CSOM and Its Implications

Get expert insights into Squamousal type of Chronic Suppurative Otitis Media (CSOM), a complex and challenging ear infection. This comprehensive presentation covers:

- Definition, causes, and risk factors of Squamousal CSOM
- Clinical presentation, diagnosis, and differential diagnosis
- Treatment options, including medical and surgical interventions
- Latest research and advances in management
- Best practices for prevention and complications avoidance

Ideal for ENT specialists, residents, medical students, and healthcare professionals seeking to enhance their knowledge and skills in managing Squamousal CSOM. Download now and share with your network!

Keywords: Squamosal CSOM, Chronic Suppurative Otitis Media, Ear Infections, ENT, Otolaryngology, Diagnosis, Treatment, Management, Prevention."

1. Squamosal Type of Chronic Otitis Media Dhanraj Sethi

2. Introduction Chronic Otitis media media is a long standing infection of a part or whole of the middle ear cleft characterised by continuous or intermittent discharge through a persistent tympanic membrane perforation.

3. Epidemiology Incidence is higher in developing countries Predisposing factors: Poor socio-economic Status, poor nutrition, lack of health education Affects both sexes All age groups

4. Types of COM

5. Differences

6. Differences in properties

7. Chronic inflammatory condition of the middle ear cleft confined to posterior part of the mesotympanum , attic and antrum associated with bone eroding disease or cholesteatoma charactersied by thick, purulent, scanty, foul smelling, blood stained persistent discharge and may be associated with perforation in pars flaccida. Squamousal type

8. CHOLESTEATOMA It is a cystic bag like structure lined by stratified squamous epithelium containing desquamated epithelial debris lying on a fibrous tissue stroma of variable thickness Skin in the wrong place Synonym: keratoma , epidermosis

9. Types of C holesteatoma Congenital Acquired Primary Secondary

10. Structure of cholesteatoma

11. Clinical Features Symptoms: • Persistent ear discharge (foul-smelling) • Hearing loss (conductive) • Tinnitus (sometimes) • Aural fullness or discomfort • History of repeated ear infections Signs : • Retraction of pars Flaccida or attic perforation • Cholesteatoma debris visible in the ear canal • Conductive hearing loss on tuning fork tests

12. Features Indicating Complications in CSOM 1 . Pain Pain is uncommon in uncomplicated CSOM . 2. Vertigo It indicates the erosion of lateral semicircular canal which may progress to labyrinthitis or meningitis. Fistula test should be performed in all cases. 3. Persistent Headache It is suggestive of an intracranial complication. 4. Facial Weakness It indicates the erosion of facial canal.

13. Features Indicating Complications in CSOM 5. A listless Child Refusing to Take Feeds Easily going to sleep points to an extradural abscess. 6. Fever, Nausea and Vomiting These are indicative of intracranial infection. 7. Irritability and Neck Rigidity These are features of meningitis. 8. Diplopia It indicates petrositis or raised intracranial tension. 9. Ataxia It indicates labyrinthitis or cerebellar abscess. 10. Abscess Round the Ear ( Mastoiditis ) It is not uncommon for a patient of CSOM ,

14. Findings and complications

15. Complications Intratemporal : • Mastoiditis • Facial nerve palsy • Labyrinthitis Intracranial: • Meningitis • Brain abscess • Lateral sinus thrombosis

16. Diagnosis Otoscopy : Attic perforation, cholesteatoma debris. Audiometry : Conductive hearing l o ss. CT scan of the temporal bone : To assess extent, ossicular damage, and complications Examination under microscope Pus for C/S X-ray both Mastoids Diagnostic Nasal Endoscopy : for Eustachian tube opening

17. Management

18. Principles of Management Short term goals ; Elimination of infection Control of otorrhoea Long term goals : Improvement of hearing Eventual healing of TM • Management based on: 1. Medical therapy 2. Surgical intervention

19. Medical Management Procedures- Aural Toileting Dry Mopping Suction irrigation under microscope Application of silver nitrate to granulation Tissue Antimetabolite - 5 - fluorouracil - Reduces the activity of squamous epithelium & curtail the production of keratin debris Topical Antibiotics Systemic Antibiotics

20. Surgical Management MYRINGOPLASTY An operation performed to repa ir or reconstruct the TM TYMPANOPLASTY An operation performed to eradicate disease in the middle ear and to reconstruct the hearing mechanisms with out mastoid surgery, with or without TM grafting. OSSICULOPLASTY An operation performed to repair or reconstruct the ossicular chain

21. Canal wall up vs canal wall down procedures Canal wall up procedures: Here the disease is removed by a combined approach through the meatus and mastoid but retaining the posterior bony meatal wall intact. avoiding an open mastoid cavity. It gives dry ear and permits an easy reconstruction of hearing mechanism. However, there is a danger of leaving some cholesteatoma behind. Canal wall down procedures: They leave the mastoid cavity open into the external auditory canal so that the diseased area is fully exteriorized . The commonly performed operations for atticoantral disease are at ticotomy , modified radical mastoidectomy and rarely, the radical mastoidectomy.

22. Comparison

23. Postoperative Care • Regular follow-up for: - Cleaning mastoid cavity. - Checking for any residual or recurrent cholesteatoma . - Hearing assessment and rehabilitation if needed. • Long-term care: Aural hygiene.

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