What is Chronic Supparative Otitis Media (CSOM)?

What is Chronic Supparative Otitis Media (CSOM)?

Chronic Suppurative Otitis Media Put simply Chronic suppurative otitis media
(CSOM) is a perforated tympanic membrane with persistent drainage from the middle ear lasting
more than 12 weeks. CSOM is initiated by an episode of acute infection. The pathophysiology of CSOM begins with irritation
and subsequent inflammation of the middle ear mucosa. The inflammatory response creates mucosal
edema and increased Middle Ear Discharge eventually leading to Tympanic Membrane Perforation. A perforation becomes permanent when its edges
are covered by squamous epithelium and it does not heal spontaneously. Types of CSOM
Clinically, it is divided into two types: 1. Tubotympanic. Also called the safe or benign type; it involves
anteroinferior part of middle ear cleft and is associated with a central perforation. There is little risk of serious complications. 2. Atticoantral. Also called unsafe or dangerous type; it involves
posterosuperior part of the cleft (i.e. attic, antrum and mastoid) and is associated with
an attic or a marginal perforation. The disease is often associated with a bone-eroding
process such as cholesteatoma. Risk of complications is high in this type. Investigations
1. Examination under microscope 2. Audiogram. It gives an assessment of degree of hearing
loss and its type. 3. Culture and sensitivity of ear discharge. It helps to select proper antibiotic ear drops
. Treatment
The aim is to control infection and eliminate ear discharge and at a later stage, to correct
the hearing loss by surgical means. 1. Aural toilet. Remove all discharge and debris from the ear. 2. Ear drops. Antibiotic ear drops are used. They are combined with steroids which have
local anti-inflammatory effect 3. Systemic antibiotics. 4. Precautions for Patient: Patients are instructed
to keep water out of the ear during bathing, swimming and hair wash. 5. Treatment of contributory causes. Attention should be paid to treat causes contributing
to disease for example adenoids and nasal allergy. 6. Surgical Treatment. Once ear is dry, Myringoplasty can be done
to restore hearing.


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