Chronic suppurative otitis media

Commonest form of chronic otitis media.

Findings include otorrhea and conduction hearing loss.

Associated with perforated eardrum, and has to persist for 6-12months to be called chronic.

Acute inflammation of the middle ear produces mucosal ulceration and breakdown of the epithelial lining.

Granuloma formation may develop into polyps in the middle ear.

The process of inflammation, ulceration, infection, granulation eventually destroy surrounding structures and lead to complications of chronic suppurative otitis media.

The most common aerobes associated with chronic otitis media are Pseudomonas aeruginosa, Staphylococcus aureus and proteus species, and the most common anaerobes are bactericides, peptococcus, and Propionibacterium acnes.

Categorized as safe or unsafe dependent on the presence or absence of cholesteatoma.

Categorized as active, with infection, or inactive in the absence of infection.

Risk factors include: multiple episodes of acute otitis media, living in crowded conditions, being part of a large family, presence of craniofacial anomalies, cleft lip, cleft palate, Down syndrome, choanal atresia, cri du chat syndrome, microcephaly-all associated with eustachian tube alterations and impaired function.

Complications can cause intracranial and extracranial problems by one of four mechanisms: direct erosion through bone, which typically leads to extradural abscess, sub periosteal abscess, meningitis, or venous sinus thrombosis; Thrombophlebitis which can lead to brain abscess; Extension through normal pathways through the cochlea oval and round windows, leading to sensorineural hearing loss and vertigo; and extension through traumatic or iatrogenic bony defects ( Harris JP et al).

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