A 35 years old w ith 6 w eeks of ear discharge which is not foul smelling. Treatment include all except -
Ans. is 'c' i.e., Mastoidectomyo Discharge for 6 weeks or more is suggestive of chronic suppurative otitis media,o Discharge is not foul semlling, which suggest tubotympanic type of disease.Tubotvmpanic diseaseo It is also known as safe ear as it does not cause any serious complications.o Infection is is limited to antero-inferior part of middle ear cleft (eustachain tube & mesotympanum) and is associated with central perforation in pars tensa of tympanic membrane. The annulus portion is always intact. Etiologyo Following etiology have been described : -Inadequately treated ASOM.ASOM causing persisteni perforation : - In most of the cases of ASOM, central perforation heals spontaneously.However, in some cases it may become permanent, i.e., persistent perforation syndrome.Presence fo focal sepsis in nose or throat (like tonsils, adenoid and sinus) causing ascending infection.Traumatic central perforation which becomes infected.Microbiologyo Pus culture in both types of aerobic and anaerobic CSOM may show multiple organ ism (PGI00).o Most commonly isolated organisms are gram negative bacilli, i.e., Pseudomonas, proteus, E.colio These organisms are not commonly found in the respiratory tract, while commonly found in the skin of external ear.Clinical featureso Profuse mucopurulant discharge which is not foul smelling, Le., non-foul smelling discharge.o Hearing loss (conductive type). If sensorineural component also occurs (i.e., mixed type), it arouses the suspicion of toxic deafness.o Sometimes, patient reports a paradoxical effect, i.e., hears better in the presence of discharge than when the ear is dry. This is due to round window shielding effect produced by discharge which helps to maintain phase differential,o There is no pain, if it occurs it is due to associated otitis externa not due to otitis media,o Since the infected area is open at both ends, discharge does not accumulate in the middle ear cavity,o Ossicular chain is mostly uninvolved, if involved only long process of incus is involved.Treatmento Treatment of choice for tubo-tympanic disease is mainly conservative'(AI94) in the form of aural toileting, suction clearing, topical & systemic antibiotics; with treatment of local cause like tonsil or adenoids,o Surgical procedure is done if there is recurring discharge or if there is deafness sufficient to cause disability. Procedure of choice is : -Myringoplasty (simple grafting of tympanic memrbane): - If the ossicular chain is intact.Tympanoplasty (Myringoplasty plus ossiculoplasty) : - If the ossicualr chain is disrupted.
Topical antibiotics
Systemic antibiotics
Mastoidectomy
Tympanoplasty
Disorders of Middle Ear (Otitis Media)