Cholesteatoma and chronic suppurative otitis media

CHOLESTEATOMA Normally middle ear cleft linings: Ciliated columnar in anterior and inferior part. Cuboidal in middle part. There is nowhere lined by keratinising squamous epithelium in middle ear cleft. Presence of this epithelium in middle ear is called cholesteatoma(skin in the wrong place)

Origin of cholesteatoma 1)Presence of congenital cell rests. 2)Invagination TM from attic or posterosuperior part of pars tensa in the form of retraction pockets(wittmacck’s theory). 3)Basal cell hyperplasia(Rueid’s theory) 4)Epithelial invasion(Habermann’s theory) 5)Metaplasia(Sade’s theory) Origin of cholesteatoma

CLASSIFICATION OF CHOLESTEATOMA 1.CONGENITAL 2.ACQUIRED,PRIMARY 3.ACQUIRED,SECONDARY

EUSTACHIAN TUBE OBSTRUCTION PERSISTENT NEGATIVE PRESSURE IN MIDDLE EAR ATTIC OR POSTERIOSUPERIOR RETRACTION POCKET PROLIFERATION OF BASAL LAYER METAPLASIA OF MIDDLE EAR MUCOSA PRIMARY ACQUIRED CHOLESTEATOMA SUBCLINICAL INFECTIONS OF MIDDLE EAR

SECONDARY ACQUIRED CHOLESTEATOMA ACUTE NECROTIZING OTITIS MEDIA REPEATED INFECTION THROUGH PERFORATION LARGE CENTRAL OR MARGINAL PERFORATION METAPLASIA OF MIDDLE EAR MUCOSA EPITHELIAL MIGRATION THROUGH PERFORATION SECONDARY ACQUIRED CHOLESTEATOMA

Expansion of cholesteatoma and destruction of bone Once cholestetoma enters middle ear cleft , it invades surrounding structures,first by following the path of least resistance, and then by enzymatic bone destruction which is caused by collagenase , acid phosphatase and proteolytic enzymes which are liberated by osteoclasts and mononuclear inflammatory cells.

Chronic suppurative otitis media It is long standing infection of a part or whole of the middle ear cleft , characterised by ear discharge and permanent perforation . Epidemiology: Higher incidence in developing countries. Both sexes and all age group s are affected. Singlemost imp. Cause of hearing loss.

Types of CSOM A)Tubotympanic : Also called safe or benign type . Involves antero inferior part with central perforation. B)Atticoantral : Also called unsafe or dangerous type . Involves the posterosuperior part and is associated with an attic or marginal perforation . Often associated with bone eroding process.

A)Tubotympanic type Pathology: 1)Perforation of pars tensa 2)Middle ear mucosa 3)Polyp 4)Ossicular chain 5)Tympanosclerosis 6)Fibrosis and adhesions

Bacteriology Pseudomonas aeruginosa , proteus , E.coli and staph aerus. Bacteroides fragilis and streptococci.

Clinical Features: 1)Ear discharge : non offensive mucoid or mucopurulent. 2)Hearing loss 3)Perforation 4)Middle ear mucosa:Red oedematous and swollen.

Investigations: 1)Examination under microscope 2)Audiogram 3)Culture and sensitivity of ear discharge 4)Mastoid X-rays.

Treatment: Aural Toilet. Ear drops. Systemic antibiotics. Precautions. Treatment of contributory causes. Surgical treatment. Reconstructive surgery.

B)Atticoantral Type Pathology: Cholesteatoma Osteitis and granulation tissue Ossicular necrosis Cholesterol granuloma

SYMPTOMS: Ear discharge. Hearing loss. Bleeding. SIGNS: Perforation. Retraction pocket. Cholesteatoma

Investigations: 1)Tunning fork test 2)Audiogram 3)X-ray mastoids and CT scan of temporal bone. 4)Culture and sensitivity of ear discharge.

Treatment: 1)Surgical: 2)Reconstructive surgery: 3)Conservative Treatment:

Tubercular otitis media SYPHILITIC OTITIS MEDIA

WILL BE CONTINUED AFTER 10 MIN BREAK