Chronic otitis media (COM) is a long-standing infection of a part or whole of the middle ear cleft characterized by ear discharge and permanent perforation. It is additionally termed as a mucosal or a safe disease as there is no serious risk of complications.
CAUSES:
As a sequela of acute otitis media usually following exanthematous fever and leaving behind a large central perforation.
Infections ascending via the eustachian tube from tonsils, adenoids and infected sinuses may be responsible for persistent or recurring otorrhoea.
Result of allergy to food items such as milk, eggs, fish, etc.
SYMPTOMS:
Ear discharge is usually moderate to profuse in quantity and sticky in nature, usually is seen in association with upper respiratory tract infections.
Hearing loss.
Other symptoms which may occur include ear ache, giddiness, facial nerve paralysis and rarely intracranial complications may occur.
SIGNS:
Perforation in the tympanic membrane of variable size with the middle ear mucosa and other middle ear structures visualized through the perforation.
Granulation or polyp arising from the middle ear.
INVESTIGATIONS:
Ear swab to identify the micro-organism and its antibiotic sensitivity.
Audiogram to assess the type and severity of hearing loss.
Radiological investigation including X-ray mastoid or HRCT scan temporal bone to identify the degree of mastoid pneumatization and plan the surgery.
TREATMENT:
The ear discharge can be controlled with medications administered based on the sensitivity report. Surgery is required to prevent recurrent episodes of ear discharge and to improve the hearing loss. Observation can be done in patients who are unfit for the procedure.
The main aim of the surgery is to remove the underlying disease and reconstruct the hearing mechanism and reconstruct the ear drum. The surgical options available includes tympanoplasty with or without a cortical mastoidectomy.
There is a possibility for this condition to reoccur after the procedure with surgical success rate being 97%. After the surgery it is necessary to be on a regular follow-up for up to 3 months to look for signs of failure or recurrence.
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