Chronic suppurative otitis media (CSOM) is a chronic inflammatory disease of the middle ear cleft that includes the tympanic membrane (eardrum), ossicles (middle ear bones responsible for hearing) and the mastoid bone (the aerated bone behind the ear). In simple terms, it can be categorized into two chief types: The mucosal variant involving only eardrum and the squamous variant involving the mastoid bone with or without cholesteatoma.
Ear discharge, recurrent or persistent for more than 12 weeks. The discharge can be profuse or scanty, foul-smelling or odourless, thick or thin, blood-stained or greenish discoloured.
Hearing loss in affected ears. Can be mild/moderate or severe/profound.
Such symptoms can extend over months or years in affected ear/s.
Signs and symptoms of impending complications in chronic ear disease:
Recent onset vertigo or imbalance.
Severe/progressive earache or headache
Nausea and vomiting
Weakness or asymmetry of the face on the affected side
Pain or swelling behind the ear, particularly in children.
Sudden progression of hearing loss/total deafness.
Fever with headache and neck stiffness/irritability 8. Altered consciousness/drowsiness
The above signs and symptoms warrant an urgent referral to the ENT surgeon for further management.
The management of chronic ear disease is nearly always surgical except in very elderly or debilitated populations who are poor surgical candidates.
Tympanoplasty: Tympanoplasty essentially means repair and reconstruction of the perforated or diseased eardrum with or without reconstruction of middle ear hearing/ossicular mechanism. The procedure involves grafting the perforated eardrum using autologous graft tissue (cartilage/fascia).
Repair of diseased ossicles (ear bones) can be done in the same sitting using middle ear implants.
Mastoidectomy: Mastoidectomy entails the removal of disease from the mastoid bone by drilling the diseased body cells of this bone behind the ear. Mastoidectomy can be of two essential types namely:
Answer: Clinical examination by an otologist/ENT surgeon followed by Examination under a microscope, Audiometry and High resolution computed tomography of the temporal bone.
Answer: This depends on your preoperative hearing level. Certain hearing loss can be corrected in the same or second surgery whereas some kinds of hearing loss involving inner ear may not be reversible.
Answer: While surgery for eardrum perforation or hearing reconstruction is elective, surgery for squamous variants or “unsafe ear” must not be deferred as it is a progressive disease and can lead to ear or brain complications in absence of definitive treatment.
Answer: While a normal follow-up after tympanoplasty or cortical mastoidectomy could all be 4-8 weeks with a native ENT surgeon, we recommend a lifelong follow-up for patients needing radical or open cavity mastoidectomy. The large cavity status post-operatively makes such patients prone to occasional discharge and wax or fungal collection that can be managed in outpatient using ear suction cleaning and relevant antibacterial or antifungal ear drops.
Answer: There are multiple methods of hearing improvement. These range from the use of hearing aids in the elderly or surgical reconstruction of a hearing mechanism using either of these methods:
Ossiculoplasty: Reconstruction of middle ear ossicles/bones using titanium implants.
Bone anchored hearing implants: For patients with open cavities or radical mastoidectomies on both sides.
Active middle ear implants (Vibrant Soundbridge): For patients with mixed hearing loss with both conductive and sensorineural hearing loss components and when patients are not comfortable wearing hearing aids.
Cochlear implants: To correct severe to profound hearing loss not amenable to any other non-surgical or surgical modality.
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