Chronic otitis media
Klára Perceová
̶ Ireversible changes of the middle ear
̶ Permanent or inetrmittent ear discharge
̶ usually eardrum perforation
̶ Conductive hearing loss
̶ Changes in temporal bone CT scans
Definition
̶ Poor function of ET leads to chronic otitis media
̶ TRUE
̶ FALSE
Permanent ET dysfunction leads to:
Middle ear underpressure (tympanometry
C), high risk of AOM
mukocilliar transport malfunction
structural changes of:
eardrum (atrophy, calcification)
-middle ear mucosa (mucosal gland
formation)
myringorupture, otorrhea
Chronic otitis media
mesotympanalis
Fluid in the middle ear,
Compact eardrum
Chronic Otitis media
with effusion (OME)
Retraction pocket filled with epidermis
Chronic Otitis media
cum cholesteatomatae
Retraction pocket,
adhesion to ossicles or promontorium
Chronic adheziv Otitis media
(cum ostitide)
̶ Poor function of ET leads to chronic otitis media
̶ TRUE
̶ Clinic:
̶ Central myringorupture
̶ Reccurent otorrhea
̶ Conductive hearing loss
̶ Bacteriology:
̶ Escherichia colli
̶ Pseudomonas aeruginosa
̶ Proteus vulgaris….
̶ Therapy:
̶ Middle ear lavage, ATB drops
̶ Surgical: myringoplasty
Chronic OM mesotympanalis
Otitis media with effusion is presented by
perforation of eardrum, at least 3 month.
TRUE
False
Chronic OM with effusion - definition
̶ Effusion (various fyzical characteristics) behind compact eardum
at least 3 month.
Chronic OME
̶ Clinic:
̶ Initially asymptomatic (liquid fluid)
̶ conductive hearing loss (viscous fluid)
̶ tinnitus
̶ reccurent AOM
OME- diagnosis
̶ Otoscopy:
̶ Initially normal eardrum
̶ Usually pulled, yellowed or bluish eardrum without light reflex
̶ later atrophy or calcification of eardrum, retraction pocket
̶ Tympanometry:
̶ Type B
̶ Type C
̶ Pure tone audiometry:
̶ Initially normal hearing (liquid fluid)
̶ Conductive hearing loss (viscous fluid)
OME - therapy
̶ watchfull waiting for 3 month
̶ Chewing-gum
̶ antihistaminics, local corticoids-only alergy
̶ Surgical:
̶ Improvement of nasal patency (adenoidectomy, nasal polyps, cave tumor of
nasopharynx!!)
̶ Fluid aspiration or VT insertion.
VT indications
̶ OME persisting 6 month or more
̶ OME with conductiv hearing loss upon 35 dB
̶ Retraction pocket
̶ Kraniofacial deformities (cleft palate)
̶ Reccurent AOM
̶ Tympanoplasty
̶ Hyperbaric chamber
̶ Serious visual defect
Otitis media with effusion is presented by
perforation of eardrum at least 3 month.
False
Otitis media with effusion is presented by
effusion behind compact eardrum at least 3
month
Chronic adhesiv OM
̶ Definition: adhesion between the eardrum, ossicles or
promontorium, with ossicles destruction due to blood vessels
lesions.
̶ Symptoms: conductive hearing loss
̶ Therapy: tympanoplasty
Cholesteatoma can be local destructive, it
can demages bone, affects N.VII, cochlea,
spreads in to brain, and causes meningitis
or abscess
TRUE
FALSE
Chronic OM with cholesteatoma
̶ Definition:
̶ Epidermal epithelium presence in middle ear cavity
Acquired (99%)
Inborn (1%)
̶ Theory of acquired cholesteatoma:
̶ Retraction pocket of eardrum (middle ear cavity underpressure
due to ET dysfunction)
Inborn
(intact eardrum)
Acquired
(retraction pocket)
Sinus
Flaccida
Tensa
Cholesteatoma – symptoms
̶ Bone destruction (ossicles, lateral semicircular canal, mastoid
processus, base of the skull)
̶ Smelling otorrhea
̶ Hearing loss (conductive or mixed)
̶ Tinnitus
̶ Vestibular symptoms: (lateral semicircular canal fistula)
̶ Tympanometry – nonspecific
̶ HRCT: temporal bone destruction
Cholesteatoma can be local destructive, it
can demages bone, affects N.VII, cochlea,
spreads in to brain, and causes meningitis
or abscess
TRUE
It is possible choose between conservative
and surgical treatment of choelsteatoma
TRUE
FALSE
Attikotomy
small cholesteatoma, retraction pocket – endaural approach
Surgery
̶ Canal wall up mastoidectomy
̶ OMCH with intermittent discharge
̶ Thick impairment of antrum and attic
̶ Wealthy pneumatization
̶ Correct function of ET
̶ Could save eardrum and ossicles
̶ Canal wall down mastoidectomy
̶ Extensive impairment
̶ Poor pneumatization
̶ Inftratemporal or intracranial
complications
̶ ET malfunction
̶ Fail of canal wall up mastoidectomy
Middle ear reconstruction (tympanoplasty)
̶ Myringoplasty: usually implant made from tragus or posterior wall of pinna
cartilage (eardrum)
̶ Tympanoplasty:
̶ plastic or metal implant (ossicles)
̶ implant made from tragus or posterior wall of pinna cartilage (eardrum)
It is possible choose between conservative
and surgical treatment of choelsteatoma
FALSE
Remeber -only surgery