Presentation on theme: "Chronic otitis media Chunfu Dai M.D & Ph. D Otolaryngology Department"— Presentation transcript:
1 Chronic otitis media Chunfu Dai M.D & Ph. D Otolaryngology Department Eye Ear Nose and Throat HospitalFudan University
2 DefinitionCOM: unresolved inflammatory process of the middle ear and mastoid associated with TM perforation, otorrhea and hearing loss.
3 Etiology Unresolved middle ear infection. Uncomplicated inflammatory process of the middle ear may evolve over time to produce persistent effusion and irreversible mucosal changeFluid contains enzymes to alter the mucosal lining of the middle ear, it results in collapse or chronic perforationObstruction of narrow communication between the antrum and the attic, the aditus.
4 Etiology Dysfunction of Eustachian tube Chronic inflammation in nose and pharynxDysfunction of immune system
6 PathologyMiddle ear mucosa is lined by secretory epithelium forming glandlike structure.Hyalinization or tympanosclerosisA healing responseIt occurs during quiescent periodsIt is formed by fused collagenous fibersIt is hardened by the deposition of calcium and phosphate crystalsConductive hearing loss is associated with masses restricting ossicular mobility
7 Pathology Ossicular erosion is frequent in COM Infection process per seNecrosis following vascular thrombosisIt most commonly affect the lenticular process of the incus and head of the stapes
8 Pathology Cholesterol granulomas Presence of yellowish masses surrounded by granulation tissue, edematous mucosa and fibrous tissueIt contains many cholesterol crystals and foreign body giant cells.
9 PathologyCholesteatoma: cystlike, expanding lesions of the temporal bone, lined by stratified epithelium and containing desquamated keratin and purulent material.ClassificationCongenital cholesteatomaAcquired cholesteatoma
10 PathologyMechanics of mucosal transformation and epithelial ingrowth have been the focal point of cholesteatomaPocket retraction: dysfunction of Eustachian tube
11 Pathology Epithelial migration: the edge of a peripheral perforation Inward growth of the surface epithelium follows papillary proliferation of the germinative layer of the pars flaccida.Metaplasia from pseudostratified ciliated columnar epithelium
15 Pathology Pathogenesis of congenital cholesteatoma: Ectodermal epithelial in proximity of the geniculate ganglion, medial to the neck of the malleus
16 Pathology Diagnosis criteria: Patients without previous history of ear disease, with normal and intact TMThe temporal bone pneumatization should be normal
17 Clinical presentations OtorrheaMalodorous associated with cholesteatomaHearing lossAir conduction threshold is within 40 dB means TM proferation with intact ossicular chainIf air-bone gap is more than 40 dB is associated with discontinuity of ossicular chain
18 Clinical presentations Physical findingsDefect in the pars tensa of TM or the pars flaccida or bothAtelectatic lesions in tensa or flaccida parsSquamous epithelial invasion may invade middle earGranumoms, polyps, tympanosclerotic plaques in middle ear
19 Radiographic evaluation Indications for image studyUncontrollable aural dischargeComplications such as facial paralysis, labyrinthitisWhen central nervous stystem involvement is suspected, MRI should be considered.Coronal CT scan is perferred
21 Differential diagnosis Middle ear carcinomaMiddle age patientLong term otorrhea with bloodOtalgiaNeoplasm in tympanumCT scan showed temporal bone destruction
22 Managements Medical treatment Goals Infection controlStabilization of processPrevention of irreversible damage and development of serious complications3%H202 clears up pus then antibiotics ear drops is used.With the decrease of pus, 3% boric glycerin, 3% boric alcohol can be usedNo aminoglycoside ear dropsNo powders containing antibiotic and erosion ear drugs
23 Managements Surgery Goals classification Safe ear: lesion removal Dry earHearing ear: reconstruction of ossiclar chainclassificationMyrigoplastyTympanoplastyTympanoplasty with mastoidectomy