| ID | 286 |
|---|---|
| Name | UNSAFE VARIETY OF CSOM |
| Cause | Unsafe CSOM involves cholesteatoma. Cholesteatoma is a non-malignant but destructive lesion of the skull base |
| Signs Symptoms | eadache. Nystagmus. Vertigo. Fever. Labyrinthitis. Facial paralysis. Swelling/tenderness behind the ear. |
| Diagnosis | safe CSOM involves cholesteatoma. Cholesteatoma is a non-malignant but destructive lesion of the skull base |
| Investigations | high-resolution temporal bone computed tomography (CT) scan |
| Management | Management depends on the extent of the disease. Accordingly the mode of treatment can be divided into three categories- 1. Resonablly safe. 2. Potentialy dangerous. 3. Dangerous. Reasonably safe: Limited disease in the attic region with good drainage & easily accessible. a. Suction clearance of all discharge, debris or small cholesteatoma sac. b. Dry moping assisted by inflation of the eustachian tube. c. Removal of small polyp or granulation. Local hydrocortisone-neomycin drop often helps, d. Ear swab is taken & culture & drug sensitivity is carried out & antibiotic is used accordingly. Potentially dangerous: Where the conservative treatment has failed. In these cases please consult with an ENT specialist for atticotomy, or atticoantrostomy. Dangerous: Radical mastoid operation. |
| Introduction | Chronic suppurative otitis media (CSOM) is one of the most common childhood infectious diseases worldwide and is a leading cause of hearing impairment in resource-limited settings |
| History | |
| Etiology | See under causes |
| Clinical Features | 1. Otorrhoea- purulent, foetid & often scanty & may be blood stained. 2. Deafness- earache, vertigo, temporal headache, facial deformity, swinging temperature etc, conductive type. 3. Examination reveals- perforation of tympanic membrane is in the pars flaccida, aural granulation in the attic, cholesteatoma is found. Cholesteatoma- a cyst like mass with a lining of stratified squamous epithelium filled with desquamating debris, which is rich in cholesterol. |
| Preventions | Avoid high temperatures and humidity in rooms in your home. Dry your ears after a shower or bath and protect them in the winter when you go out. Take care to dispose of used tissues and wash your hands thoroughly after coughing or sneezing. |
| Treatment | (unsafe CSOM), classical radical mastoidectomy, modified radical mastoidectomy or the 'combined approach tympanoplasty' (anterior tympanotomy plus extended mastoidectomy) may be used depending on the extent of cholesteatoma and, more importantly, the experience of the surgeon |
| Complications | Complications include subperiosteal abscess, mastoid abscess, petrositis, labyrinthitis, and facial nerve palsy. Intracranial complications ranging from meningitis, brain abscess, lateral sinus thrombosis, and extradural abscess can also occur |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology | Unsafe CSOM involves cholesteatoma |
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