Chronic Suppurative Otitis Media (CSOM)
CSOM is chronic inflammation and tissue damage of middle ear. It also cause inflammation in mastoid.
CSOM Develop occurs when prolonged effusion and negative pressure behind tympanic membrane.
CSOM cause damage to eardrum and continuing drainage through hole of tympanic membrane.
Etiology
Eustachian tube dysfunction
Recurrent bacterial infection
Adenoid hypertrophy
Chronic sinusitis
Pathophysiology
CSOM initiated with acute infection. It develops ofter prolonged time of inflammation in middle ear, acute otitis media, perforation of eardrum, eustachian tube dysfunction (dysfunction of eustachian tube cause middle ear negative pressure that cause perforation or retraction of tympanic membrane.
Due to long-lasting chronic inflammation inflammatory mediators weakening the tympanic membrane and causing mucosal edema.
Continuing inflammation leads to mucosal ulceration and errosion of epithelial lining.
Long- lasting pressure on middle ear can damage mastoid bone, middle ear, ossicles continuity, cholesteatoma (cyst like growth)
Classification of CSOM
1. Tubotympanic Type
a. Tubal type
Infection reaches through eustachian tube, infection lie in nose, sinus or nasopharynx.
b. Tympanic type
Infection reaches middle ear through defect in tympanic membrane.
2. Atticoantral Disease
Dangerous type of CSOM. Because of chronic negative pressure, formation of cholesteatoma and infamatory granular tissue cause erosion of bone.
Clinical Manifestations
1. Hearing loss
2. Sense of fullness in ear/ blockage of ear
3. Fouel smelling ear drainage
4. Vertigo; balance problem
5. Persistent deep ear pain
6. Headache
7. Tenderness of mastoid process
8. Middle ear mucosa, red, edematous, swollen
Diagnostic Evaluation
1. Culture
Specimen form fresh perforation or tympanocentesis
2. CT scan
Reveals bone erosion from cholesteatoma, ossicular errosion.
3. MRI scan
MRI of temporal bone; reveals dural inflammation, intracranial abscesses.
4. Audiogram
To identify extent of hearing loss.
Management
1. Antibiotics
Amoxicillin, Amoxicillin-clavulanic, Ciprofloxacin/dexamethasone otic drops.
2. Aural Toilet
Infected middle ear canal filled with exudates. By Aural toilet method, remove the such content.
3. Control of granulation tissue
Inflammatory granular tissue fills middle ear and external auditory canal.
Apply tropical antimicrobial agents from penetrating to site infection.
Use of topical antimicrobial drops first step in controlling granulation.
Otic drops help in reduce granulation tissue by eliminating infection and by removing irritating inflammation.
Silver nitrate medication used for cauterization and excision of granulation tissue done.
Surgical Management
1. Tympanomastoidectomy; treatment for CSOM consis of removing and controlling granulation tissue within middle ear, mastoid and mastoid antrum (air space).
2. Myringoplasty
Closure of perforated eardrum.
3. Myringotomy
Small incision made in tympanic eardrum (eardrum), allow the fluid to drain and prevent eardrum from repturing.
Through this procedure insert small ear tubes called tympanostomy tubes in eardrum. These tube allow the passage of air and drainage of fluid.
4. Tympanoplasty
Surgical repair or surgical correction of perforated eardrum.
Tympanic membrane grafting used to reconstruction of tympanic membrane.
Types of Tympanoplasty
1. Type l Tympanoplasty
Also called myringoplasty, it involves only restoration of perforated eardrum by grafting.
2. Type 2 Tympanoplasty
Used for repair tympanic membrane perforation with erosion of malleus, grafting lie onto incus.
3. Type lll Tympanoplasty
Repair of tympanic membrane and destruction of ossicles. Grafting lie onto stapes head. The malleus and incus defected.
4. Type IV Tympanoplasty
Repair of tympanic membrane and grafting is lie onto stapes footplate.
5. Type V Tympanoplasty
Type V tympanoplasty is used when footsteps of stapes is fixed. Repair of fixed stapes footplate.
5. Ossiculoplasty
Surgical reconstruction of middle ear bone to restore hearing.
6. OtoLAM
Laser-assisted myringotomy, make a tiny hole in eardrum with laser that immediately results in draining of fluid and pain relief.
7. Adenoidectomy
Surgical procedure to remove adenoids.
Enlarged adenoids interfere with eustachian tube function.
8. Mastoidectomy
This procedure involves incision, drainage and surgical repair of mastoid process.
Type of Mastoidectomy
1. Simple mastoidectomy
Open mastoid bone and remove infected air cells and drains the middle ear.
In this procedure opens mastoid bone and remove infected air cells, and drains middle ear.
2. Radical mastoidectomy
Remove eardrum and middle ear structure (except the stapes footplate).
Eradication of all diseased tympanic membrane and ossicle structure and remove mastoid air cell.
Tympanic membrane grafting placed.
3. Cortical mastoidectomy
Removal of mastoid air cells without affecting the middle ear integrity.
Infected mastoid air cells parts removed.
4. Modified radical mastoidectomy
Not all middle ear structure removed and eardrum rebuilt.
Prevention
1. While swimming use ear plugs, drying the ear after swimming or showering
2. Don't put any foreign object to clean wax out of ear.
3. Prevent the child from upper respiratory tract infection.
4. Keep ath ear dry and clean.
Nursing Management
Nursing Diagnosis
1. Pain related to inflammation and pressure on tympanic membrane
2. Risk of infection related to eustachian tube dysfunction
3. Impaired verbal communication ralated to hearing defects
4. Altered sensory perception related to middle ear infection
5. Fear and anxiety related to progression of disease
Postoperative care
1. With mastoidectomy and Tympanoplasty, ear packing removed after 3 weeks or as per instruction.
2. Prescribed ear drops started 3 week after surgery then packing is removed at 5 weeks.
3. Follow ups, care for until canal or cavity is well epithelialized.
4. Monitor the sign of recurrent cholesteatoma noted.
5. In case of hearing reconstruction/ossiculoplasty; audiogram for 3 months
7. If mastoidectomy performed, irrigation and cleaning of mastoid cavity with mixture of solution alcohol and vinegar and then drying.
Complications
Acute necrotic otitis
Development of chronic otitis media
Petrositis; infection of petrous portion of temporal bone.
Acute labyrinthitis
Otitis hydrocephalus
Meningitis
Encephalitis
0 Comments