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Chronic Suppurative Otitis Media


Presentation

  • Ninety percent patients presented with tubotympanic variety and 10% patients presented with attico-antral variety. Bacteriologically pure growth was found in 79.09% cases, mixed growth in 10.91% cases, no growth in 10% cases.[ncbi.nlm.nih.gov]
Pseudotumor
  • Inflammatory myofibroblastic tumors, also known as inflammatory pseudotumors, include a diverse group of lesions characterized by inflammatory cell infiltration and variable fibrotic responses. Their occurrence in the temporal bone is unusual.[ncbi.nlm.nih.gov]
Loss of Hair
  • This can cause the loss of hair cells in the cochlea, leading to sensorineural hearing loss. Pseudomonas aeruginosa and Staphylococcus aureus are the most predominant pathogens that cause CSOM.[ncbi.nlm.nih.gov]
Insect Bite
  • It may be of odontogenic or traumatic origin or may arise from insect bites, burns or surgical infections.[ncbi.nlm.nih.gov]
Periorbital Edema
  • In 24 cases (26.09%), the patients complained of mild periorbital edema and the condition was classified as grade 2. Four cases (4.35%) were classified as grade 3 because of severe edema with erythema on eyelids.[ncbi.nlm.nih.gov]
Ear Discharge
  • METHODS: Samples from ear discharge and the nasopharynx were collected and cultured from 152 patients with ear discharge and perforation of the tympanic membrane.[ncbi.nlm.nih.gov]
Otalgia
  • Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage, mode of onset, otalgia, hearing loss, location of tympanic membrane perforation[ncbi.nlm.nih.gov]
  • The otorrhea should occur without otalgia or fever. Fever, vertigo and otalgia should prompt urgent referral to exclude intratemporal or intracranial complications. Hearing loss is common in the affected ear.[patient.info]
  • Eight of the patients had otalgia, and the duration of otorrhoea was 12 months in 4 of those patients.[wwwnc.cdc.gov]
  • In acute otitis media, otalgia is the most common complaint. Other common signs and symptoms include otorrhea, hearing loss, headache, fever, and irritability.[radiopaedia.org]
  • Tympanoplasty, a surgery that seals the perforation, prevents the translocation of bacteria from the external ear canal into the middle ear; the uninflamed, protected middle ear mucosa deters future development of CSOM Early symptoms of aural fullness, otalgia[emedicine.medscape.com]
Hearing Problem
  • If your child isn't old enough to say "My ear hurts," here are a few things to look for Tugging at ears Crying more than usual Fluid draining from the ear Trouble sleeping Balance difficulties Hearing problems Your health care provider will diagnose an[icdlist.com]
  • Screening for pre-school and school-age hearing problems: European Consensus Statement. Int J Pediatr Otorhinolaryngol 2012;76(1):120-121. [ ] 11. Skarżyński H, Piotrowska A.[samj.org.za]
Facial Pain
  • BACKGROUND Gradenigo's syndrome includes the triad of suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve.[ncbi.nlm.nih.gov]
Neck Swelling
  • We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling.[ncbi.nlm.nih.gov]
Vertigo
  • A positive history of vertigo was reported in 53.5% of the cases. Rotatory chair abnormalities were found in 70% of the cases, caloric hypofunction was found in 61.6%, and vestibular myogenic evoked potentials were abnormal in 25%.[ncbi.nlm.nih.gov]
  • Vertigo Continuous or intermittent episodes of vertigo may occur, since the organ of hearing and balance are one anatomically connected organ.[entspeciality.com]
  • The principal reasons for failure of discharge on the day of surgery were asthenia (6 cases), vertigo and asthenia (4 cases), undetermined (2 cases).[audiologyresearch.org]
  • Features indicating complications of CSOM Pain Vertigo Persistent headache Facial weakness A listless child refusing to take feeds and easily going to sleep Fever, nausea and vomiting Irritability and neck rigidity Diplopia Ataxia Abscess around ear 18[slideshare.net]
Dizziness
  • Typically, associated with conductive hearing loss, untreated CSOM can result in serious complications such as mastoiditis, facial nerve paralysis, cholesteatoma formation, dizziness, and intracranial infections.[neurotucson.com]
  • 2 Clinical picture Patients with CSOM may consult a doctor with one of the following: 2 • a newly discharging untreated ear • a persistently discharging initially treated ear • a recurrently discharging ear • a discharging ear with headache, fever, dizziness[cmej.org.za]
  • If there is already toxic inner ear damage, with or without tinnitus or dizziness, the procedure should take place regardless.[ims.uniklinik-freiburg.de]
Communicating Hydrocephalus
  • Computed tomographic scan of the brain revealed left mastoiditis with cholesteatoma and moderate communicating hydrocephalus. The patient was subjected to left radical mastoidectomy, and an attico-antral cholesteatoma was removed.[ncbi.nlm.nih.gov]

Workup

  • [Figure 2] CSOM was considered to be the cause of the cortical venous thrombosis as the workup to rule out non-infective causes was negative.[jacmjournal.org]
  • […] lateralization can also cause a conductive loss Sensorineural hearing loss is rarely seen but is considered a serious complication Vertigo can occur during any middle ear procedure and is usually self-limiting; however, if it is severe or persistent, further workup[emedicine.medscape.com]
Calcium Increased
  • increasing (OR   0.09; 95% CI: 0.01-0.71) were prime risk factors for CSOM.[ncbi.nlm.nih.gov]

Treatment

  • Clinical presentation, imaging studies, operative findings, surgical treatment, and postoperative results were evaluated.[ncbi.nlm.nih.gov]

Prognosis

  • The presence of a hemorrhagic lesion on computed tomographic scan and deep coma at presentation indicate poor prognosis.[ncbi.nlm.nih.gov]
  • The presence of a hemorrhagic lesion on computed tomographic scan and deep coma at presentation indicate poor prognosis. Footnotes[stroke.ahajournals.org]
  • Intratemporal complications include: Petrositis Facial paralysis [ 17 ] Labyrinthitis Intracranial complications include: Lateral sinus thrombophlebitis Meningitis Intracranial abscess Sequelae include: Hearing loss Tympanosclerosis Prognosis [ 2 ] Prognosis[patient.info]
  • Exact prevalence in different age groups is unknown; however, some studies estimate the yearly incidence of CSOM to be 39 cases per 100,000 in children and adolescents aged 15 years and younger. [14] Prognosis Patients with CSOM have a good prognosis[emedicine.medscape.com]
  • Prognosis The natural history of chronic suppurative otitis media is poorly understood.[aafp.org]

Etiology

  • Preauricular incision, disturbance of venous and lymphatic drainage, and preseptal cellulitis were the possible etiological factors.[ncbi.nlm.nih.gov]
  • However, poorly treated AOM was found to be the commonest etiological factor. The provision of adequate health facilities and eradication of poverty possibly will reduce the prevalence of pediatric CSOM in our environment.[sciencedomain.org]

Epidemiology

  • Abstract To evaluate the shift in epidemiological and complication profiles of chronic suppurative otitis media (CSOM) over two decades in a resource-limited economy.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of the concurrent complications is discussed.[ncbi.nlm.nih.gov]
  • Pathophysiology CSOM is initiated by an episode of acute infection. The pathophysiology of CSOM begins with irritation and subsequent inflammation of the middle ear mucosa. The inflammatory response creates mucosal edema.[emedicine.medscape.com]
  • Its pathophysiology begins with irritation and subsequent inflammation of the middle ear mucosa. The most important pathological factors in CSOM are dysfunction of the Eustachian tube and bacterial infection.[jemds.com]
  • (B) Pathophysiology (i) Progressive inflammation & hyperaemic thickening of mucoperiostium Þ periostitis. (ii)Obstruct’n of aditus ad antrum ("bottleneck") B/W mastoid & middle ear. (iii) Accumulation of serous then purulent exudates in the cells.[ent.com.au]

Prevention

  • The patients suffering from ear perforation or having a hole in eardrum require preventing entry of water in the ear.[ncbi.nlm.nih.gov]

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