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1. CSOM - TUBOTYMPANIC

2. DEFINITION
CSOM is a long standing infection of a
part or whole of middle ear cleft
characterised by ear discharge and
permanent perforation.

3. EPIDEMIOLOGY
Higher in developing countries
- poor socioeconomic standards
- poor nutrition
- lack of health education
Affects both sexes
All age groups

4. TYPES
Tubotympanic Atticoantral
Discharge Profuse, mucoid, Scanty, Purulent,
odourless foul smelling
Perforation Central Attic or Marginal
Polyp Pale Red and fleshy
Cholesteatoma Absent Present
Granulations Uncommon Common
Complications Rare Common
Audiogram Mild CD CD or Mixed

5. TUBOTYMPANIC
Aetiology
Sequela of acute otitis media
Ascending infections via eustachian tube from
infected tonsils, adenoids, infected sinuses
Allergy to ingestants such as milk, egg,fish etc.

6. PATHOLOGICAL CHANGES
1. Perforation of Pars tensa
 central perforation
2. Middle ear mucosa
 inactive – normal
 active – oedematous and velvety

7. 3. Polyp
 smooth mass of oedematous and
inflammed mucosa ; pale
4. Ossicular chain
 intact and mobile
 necrosis of long process of incus

8. 5. Tympanosclerosis
 hyalinisation and calcification of
subepithelial conn. tissue.
 white chalky deposits on
ossicles, promontory, joints, tendons, ov
al window and round window.
6. Fibrosis and adhesions
 due to healing process

9. BACTERIOLOGY
Aerobic
 Ps. aeruginosa
 Proteus
 E coli
 Staph aureus
Anaerobic
 Bact. fragilis
 Anaerobic streptococci

10. CLINICAL FEATURES
1. Ear discharge
Non offensive, mucoid or mucopurulent.
Constant or intermittent.
2. Perforation
Central - anterior, posterior or inferior to
handle of malleus.
Small, medium or large.

11. 3. Hearing loss
Conductive
Round window shielding effect
Hears better in the presence of
discharge than dry ear.
Long standing cases – mixed type
4. Middle ear mucosa
Pale pink and moist – normal
Red oedematous and swollen - inflammed

12. INVESTIGATIONS
1. Examination under microscope
 Granulations
 Status of ossicular chain
 Ingrowth of sq epithelium from edges
of perforation
 Tympanosclerosis
 Adhesions

13. 2. Audiogram
Conductive hearing loss
3. Culture and sensitivity of ear discharge
Select proper antibiotic ear drops
4. Mastoid X-rays
Usually sclerotic but may be
pneumatised with clouding of air cells
No bone destruction

14. TREATMENT
to control infection
eliminate ear discharge
correct hearing loss

15. 1. Aural toilet
- remove discharge and debris from ear
 dry mopping with absorbent cotton buds
 suction clearance under microscope
 irrigation with sterile NS

16. 2. Ear drops
Neomycin, Polymyxin,
Chloromycetin, Gentamycin
 Steroids
3. Systemic antibiotics
a/c exacerbation of c/c infected ear

17. 4. Precautions
keep water out of ear
hard nose blowing avoided
5. Treatment of contributory cause
infected tonsils, adenoids, nasal
allergy

18. 6. Surgical treatment
aural polyps and granulations if
present
7. Reconstructive surgery
myringoplasty