1. CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) by: Dr. Saad Al Asiri MD, DLO, KSF, Rhino General Secretary Assistant for Training & Program Accreditation ENT Consultant and Rhinologist

15.  Definition: long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and permanent perforation

16. Tubotympanic (safe)atticoantral (unsafe) Dischargeprofuse mucoidscanty purulent Foul smell PerforationcentralMarginal GranulationuncommonCommon PolyppaleRed, fleshy CholesteatomabsentPresent ComplicationrareCommon Audiogrammild, moderate, conductive, deafness Conductive or mixed deafness TYPES Differences between atticoantral and tubotympanic type of CSOM

17.  Chronic non - suppurative OM "no pus, no perforation” A - OM with effusion B - adhesive OM  Chronic suppurative OM " pus + perforation A - tubotympanic safe B - atticoantral unsafe  OME - OM with effusion → done by Dr. Samir Classification of Chronic OM

18.  Etiology  Environmental  Genetic  Previous OM + effusion  URTI  ET dysfunction  C/E  otorrhea - details  Deafness  Other FN, pain, blood discharge  R/O complication

19.  Otoscopic finding  Discharge  Perforation  Central  Attic "marginal“  Polyp  Granulation  Tympanosclerosis

20.  Eustachian Tube " E T"  Surgical anatomy  Difference between infant and adult  Function –  ventilation and regulation of m. Ear  pressure protection e.g. Reflex of secretion  Nasopharynx  Clearance of M. Ear secretion

21.  Causes of ET obstruction  URTI + sinusitis  Allergy, N. Polyp  Severly DNS  Adenoid  Cleft palate

22.  Total obstruction ↓  Absorption of ME gases ↓  Negative pressure in ME ↓  Retraction of TM ↓  Transudate in ME + hemorrhage ↓  OM effusion ↓  Atelectatic ear " no M. Ear space" ↓  Retraction pocket ↓  Cholesteatoma

23.  Classification of cholestreatoma  Congenital  Acquired  Pathogenesis of cholesteatoma  Migration of sq. Epithelium  Metaplasia

24.  Clinical symptoms → indicating complication in CSOM  Pain  Vertigo  Persistent headache  Facial weakness  Fever & vomiting  Irritability & neck rigidity  Diplopia  Ataxia  Abscess around the ear

25.  Bacteriology  Mixed organism aerobes + aneorbes  Investigation  Ear swab  Microscopic examination  Imaging  Audiology

26.  Treatment  Ear toilet  Ear drops  Ear swab C/S

27.  When surgery is indicating  To improve hearing  To prevent discharge  Any complication  Myringoplasty  Tympanoplasty  Mastoidectomy 3/5/2016

28.  Effects of cholesteatoma  Focus of infection "Persistent"  Bone erosion where to go "explain“  Complication of suppurative otitis media

29.  Factors influencing development of complication  Age  Poor socioeconomic group  Virulence of organisms  Immunity of patient  Presence of cholesteatoma 3/5/2016

30.  Pathway of spread of infection  Direct of bone erosion  Venous thrombophatitis  Preformed pathways  Dehiscence  Patent suture  Post surgery  Oval and round window

31. A. Intratemporal within temporal bone  Mastoiditis  Petrositis  F.n. Paralysis due acute & chronic labyrinthitis + lab  Fistua

32. A. Intracranial  Extradural abscess "the commenist "  Subdural abscess  Meningitis  Brain abscess - 50% ear isthe cause of brain abscess  Hydrocephalus 3/5/2016

33.  Investigation:  CT  MRI  Treatment  Manage ear infection  Manage the complication

34. 3/5/2016