Chronic Otitis Media - Definition, Symptoms, Complications and Treatment

Chronic Otitis Media

Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media

Chronic Otitis Media (COM) is the term used to describe a variety of signs, symptoms, and physical findings that result from the long-term damage to the middle ear by infection and inflammation. This includes the following: perforation of the eardrum, scarring or erosion of the small, sound conducting bones of the middle ear, chronic or recurring infected drainage from the ear damage to surrounding structures such as the balance or hearing organs of the inner ear, the facial nerve, or the brain and its coverings, known as the meninges.

Chronic Otitis Media - Definition

Definition of Chronic Otitis Media
Definition of Chronic Otitis Media

Chronic Otitis Media (COM) or Chronic Suppurative Otitis Media (CSOM) is defined as a persistent ear infection (greater than three months in duration) in the presence of a tympanic membrane perforation and continuous or recurrent ear drainage.

The tympanic membrane is perforated in CSOM. If this is a tubotympanic perforation, it is usually 'safe', whilst atticoantral perforation is often 'unsafe'.

Safe or unsafe depends on the presence of cholesteatoma:

• Safe CSOM is CSOM without cholesteatoma. It can be subdivided into active or inactive depending on whether or not infection is present.
• Unsafe CSOM involves cholesteatoma. Cholesteatoma is a non-malignant but destructive lesion of the skull base.

Chronic Otitis Media - Symptoms

Symptoms of Chronic Otitis Media
Symptoms of Chronic Otitis Media

A chronic ear infection can cause milder symptoms than an acute ear infection. Symptoms may affect one or both ears and may be constant or come and go. The main symptoms of the disease are hearing loss and ear discharge. Diagnosis can be made by ear examination and ear tomography. Audiometric hearing tests are also requested in patients planned for surgery.

Typically, a conductive hearing loss is also present. If left untreated, CSOM can result in serious complications such as mastoiditis, facial nerve dysfunction, cholesteatoma formation, dizziness and intracranial disease.

Signs include:

• a feeling of pressure in the ear
• mild ear pain
• fluid draining from ears
• low fever

Chronic Otitis Media - Complications

Complications of Chronic Otitis Media
Complications of Chronic Otitis Media

Complications of CSOM are rare but potentially life-threatening.

Intratemporal complications include:

• Petrositis
• Facial paralysis
• Labyrinthitis

Intracranial complications include:

• Lateral sinus thrombophlebitis
• Meningitis
• Intracranial abscess

Sequelae include:

• Hearing loss
• Tympanosclerosis

Chronic Suppurative Otitis Media (CSOM)

Chronic suppurative otitis media is a persistent drainage (discharge) of the middle ear that lasts longer than 6-12 weeks, accompanied by a perforated eardrum. Chronic aspiration may occur with cholesteatoma or cholesteatoma, and both cases may have a very similar clinical history (cholestetaom or cholesteatoma, a tumor of the epithelial cells containing bone epithelial cells that can dissolve bone tissue by acting as a tumor. In chronic suppurative otitis media, it may be difficult to treat the hole in the tympanic membrane, in which the discharge of the chronic infection.

Chronic suppurative otitis media may begin with an acute infection attack. The pathophysiology of CSOM begins with irritation of the middle ear mucosa and then inflammation. Inflammatory response is caused by mucosal payment. After continued inflammation, mucosal ulceration leads to disintegration of the epithelial layer. Inflammation, ulceration, infection, and granulation can lead to various complications of KSOM, resulting in the disappearance of the surrounding bony margins that can continue the cycle of tissue formation.

Dagnosis of Chronic Otitis Media

The diagnosis of CSOM requires a perforated tympanic membrane. These holes may be traumatic after tube insertion or after decompression of acute otitis media through a tympanic perforation.

Risk Factors of Chronic Otitis Media

The risk of developing CSOM increases with the following conditions:

- History of multiple attacks of acute otitis media
- Living in crowded conditions
- Exposure to cigarette smoke or smoking
- Presence of craniofacial anomalies (cleft palate and lip, Down Syndrome, Cri Du Syndrome, Koanal Atresia, DiGeorge Syndrome, microcephaly)
- Low socioeconomic status
- Frequent upper respiratory tract infection
- Nasal obstruction (adenoid hypertrophy, septum deviation, turbinate hypertrophy, nasal polyps ...)
- Continue to day care facilities

What is Mastoiditis?

Mastoit Bone lava, which is located just behind the auricle and behind the middle ear and containing the sacs like the inner lung, is defined roughly as the "mastodit". The definition of mastoiditis involves all the inflammation processes of mastoid air cells of the temporal bone. Since the mastoid is adjacent to the middle ear and connects with the anatomical clefts between the middle ear and the mastoid, almost every child or adult may have acute otitis media (AOM) or mastoidititis in chronic otitis media. In most cases, the symptomatology of the middle ear is predominant (eg, fever, pain, conductive hearing loss), and the disease within the mastoid is not considered a separate entity.

Acute Mastoiditis

Acute mastoiditis is associated with AOM. In some patients, the infection spreads beyond the cleft mucosa in the middle ear and causes osteitis (bone inflammation and bone inflammation) in the periosteum in the mastoid air cell system or mastoid process, either directly through the cortex, or indirectly through the emissary vein, causing mastoidity.

Chronic Mastoiditis

Chronic mastoiditis is mostly associated with chronic suppurative otitis media and especially cholesteatoma formation. Cholesteatomas are benign populations of the squamous epithelium that can alter and alter the normal structure and function of the surrounding soft tissue and bone. This destructive process is accelerated in the presence of active infection by secretion of osteolytic enzymes by epithelial tissue. As seen in the above photo and at the end of the link, in the patient with chronic otitis media, the ear tomography (temporal bone CT) of the patient revealed a soft tissue mass filling the left mastoid bone cells, and the middle ear destroyed the ossicular chain.

Chronic Otitis Media and Mastoiditis - Treatment

Treatment of Chronic Otitis Media
Treatment of Chronic Otitis Media

Treatment of chronic otitis media

General treatment principles in patients with chronic otitis media are inflammation therapy and hearing protection. It is important for people with this disease to protect their ears from water contact. For the treatment of inflammation, topical drip treatment and oral antibiotic treatment are applied. Surgical treatment involves tympanic membrane surgery (myringoplasty and tympanoplasty) and mastoidectomy operations in patients with inflammatory islets trapped in the middle ear or cholesteatoma.

It is especially important to treat underlying diseases that facilitate chronic middle ear inflammation before ear surgery.

For example, termination of smoking, treatment of nasal congestion ...

Patients with CSOM that is unresponsive to topical and/or systemic medical therapy with appropriate aural toilet and control of granulation tissue require surgery.

Current goals for surgery for chronic ear disease include a dry, safe ear and the preservation of the normal structure and functioning to the greatest extent possible. In case of chronic mastoiditis with chronic otitis media, surgical procedures involving surgical procedures for the middle ear ossicles, surgical procedures for the eardrum and cleaning of mastoid cells in the middle ear, cleaning of the mastoid cells and, if possible, reconstruction of the auditory surgery, are planned.

Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media
Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media

In patients with CSOM without cholesteatoma, surgery is considered if the perforation is persistent and long-standing and causes clinical symptoms, such as recurrent ear discharge and hearing loss. The age, general physical condition, fitness for general anesthesia, and coexisting diseases of the patient also play an important role in considering surgery.

General indications for surgery are as follows:

• Perforation that persists beyond 6 weeks
• Otorrhea that persists for longer than 6 weeks despite antibiotic use
• Cholesteatoma formation
• Radiographic evidence of chronic mastoiditis, such as coalescent mastoiditis
• Conductive hearing loss

Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media
Chronic Otitis Media - Definition of Chronic Otitis Media - Symptoms of Chronic Otitis Media - Complications of Chronic Otitis Media - Treatment of Chronic Otitis Media

For patients with early or mild CSOM cholesteatoma, aural toilet and repeated suction clearance of the ear with watchful expectancy may be performed; for patients with advanced disease, exploration of the mastoid and tympanoplasty is recommended.

Contraindications (relative and absolute) to surgery for tubotympanic disease are as follows:

• Surgery on the only hearing ear
• Poor general physical condition, old age, or debility that makes general anesthesia risky
• Patients unwilling to undergo surgery
• Surgery on patients with unilateral vestibular ablation
Contraindications to surgery for atticoantral disease are as follows:
• Early or mild cholesteatoma amenable to aural toilet
• Patients who are severely ill and those with complications secondary to cholesteatoma, such as a brain abscess (drainage of the brain abscess and intravenous administration of antibiotics should be considered first)

Videos about the subject and descriptions:

Bad Smelling Inflammatory Ear Stream Can Be a Sign of "Cholesteatoma"!

Cholesteatoma is a rare abnormal collection of skin cells within the ear. By acting like a tumoral tissue, it has properties that can damage the surrounding bone tissue and the surrounding brain membrane, brain and facial nerve. It is composed of encrusted ball-shaped, skin cells. Cholesteatomas usually develop as cysts or pouches that shed old skin layers that accumulate in the middle ear. Over time, it may increase the size of the cholesteatoma and break down the sensitive bones in the middle ear and cause hearing loss.

Mastoidectomy Operation Video - 1

Mastoidectomy Operation Video - 2

The general principles of treatment in patients with chronic otitis media, inflammation treatment and hearing protection. It is important for people with this disease to protect their ears from contact with water. Topical drop therapy and oral antibiotic therapy are applied for the treatment of inflammation. In the surgical treatment, mastoidectomy operations are performed in patients with eardrum surgeries (myringoplasty and tympanoplasty) directed to the hole in the eardrum and in patients with inflammation islets or cholesteatoma trapped in the middle ear.

About The Mastoidectomy Operation

Cortical mastoidectomy or simple mastoidectomy operation

Cortical mastoidectomy or simple mastoidectomy (also known as Schwartze procedure) is carried out without affecting the middle ear in the removal of mastoid air cells. This is usually done for inflammation of the mastoid bone. In cases where medical treatment is not effective, it is a surgical procedure to remove inflamed bone tissue with an incision made behind the ear. Because of the widespread use of antibiotics in this surgery, there is rarely a need for it today.

Modified radical mastoidectomy operation

Modified radical mastoidectomy is an operation designed to remove only the inflamed mastoid bone and external ear canal wall if the cholesteatoma is not spread to the middle ear, the head of the malleus bone or the body of the incus bone. Channel wall down can be used in the same sense as mastoidectomy. This procedure is usually performed on the ear, which is the only hearing and cholesteatoma. Since all or some of the structures in the middle ear are intended to be preserved; is a surgical procedure in which hearing is protected.

Radical mastoidectomy operation

In radical mastoidectomy, all of the structures in the middle ear and the outer ear canal are removed, and the mastoid bone and the middle ear are converted into a single cavity. In other words, in radical mastoidectomy operation, the hearing is not preserved; In the modified radical mastoidectomy, it is tried to protect the hearing structures. In other words, this procedure is a procedure involving simple mastoidectomy and radical mastoidectomy, considering the magnitude of the procedure.

Again, as with simple mastoidectomy and radical mastoidectomy, the skin is removed with a retroauricular incision made behind the ear. The bone area of the mastoid is removed by a lap and a microscope. The outer ear canal wall between the middle ear and the mastoid bone, which is called a "bridge", is lowered. Cholesteatoma is removed. Damage to the tympanic membrane. The middle ear structures are preserved. The damaged area of the eardrum is repaired. The cavity is placed in a spongostan. The operation is terminated by placing a buffer in the outer ear canal.

Source links:

  • Chronic Suppurative Otitis Media Treatment & Management

  • Ear infection - chronic: MedlinePlus Medical Encyclopedia

  • Chronic Suppurative Otitis Media | Doctor |

  • Middle Ear Infection (Otitis Media) Symptoms, Home Remedies ...

  • Diagnosis and Treatment of Otitis Media - American Family Physician

  • Fact Sheet: Chronic Otitis Media (Middle Ear Infection) and Hearing ...

  • Chronic Suppurative Otitis Media - Pediatrics in Review

  • Ear Infection - Chronic Treatment - Ear Infection - Chronic Health ...

  • Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

    Private Office:
    Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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