JOURNAL READING: CURRENT CONCEPTS

IN THE PATHOGENESIS AND TREATMENT

OF CHRONIC SUPPURATIVE OTITIS MEDIA
Pembimbing: dr. Khairan Immansyah, Sp THT-KL, M.Kes

Oleh: Adi Baskoro 11 2015 279 FK UKRIDA

Sri Handawati Wijaya 11 2015 116 FK UKRIDA
Chronic Suppurative Otitis Media
Inflammation of the middle ear associated with infection
Hearing Impairment
Acute
Sign : BPFE
Symptoms : OIF

Chronic
Persistent drainage
Perforated ear drum
CSOM
Perforated Otitis Media
OMA CSOM (after 2 months)
Factor that affect OMA into CSOM such as :
Minimal treatment , immune response , high virulency, bad hygiene
Perforated spot : central, marginal, attic
CSOM types
Benign type CSOM
Inflammation limited to mucosa and
not spreading to bone
Central perforation
Cholesteatoma(-)
Simple mastoidectomy
Malignant type CSOM
=Bone type CSOM
Marginal or attic perforation
Cholesteatoma (+)
Abcess/Retroauricular
fistula/Polyp/Granulated tissue(+)
Radical Mastoidectomy
Diagnosis
Clinical presentation
Otoscope
Audiometry/BERA ( hearing loss )
Resistance and Culture test
Rontgen
Epidemiology
65-350 millions worldwide, especially developing country
31 million cases of CSOM 22,6% in children less than 5 years
Appears very early in life, on average before 1 year of age
Risk Factors:
Attending Children care centres
Having mother who reported history of purulent ear discharge
Having smokers in household
Upper respiratory tract infection
Epidemiology
In US 70% US children have at least one acute middle ear infection before 3 years
of age
Microbiology
Pathogenesis
Enviromental Bacterial Host Genetic risk factors
Bacterial biofilms
Biofilms Resistant to antibiotics & antimicrobe compound
Biofilms attach firmly to damage tissue such as :
Exposed osteotic bone
Ulcerated middle ear mucosa
Otological implant ( tympanostomy tubes )
Pathogenesis
Hearing Loss
Most common finding
Obstruction in the transmission of sound waves from the middle ear to the inner
ear
The presence of fluid (pus) can hinder the conductance of sound to the inner ear
Amount effusion : magnitude and severity
 Chronic infection of the middle ear oedema of the middle ear lining and discharge
perforation of M.T ossicular chain disruption CHL

SNHL results either from inner ear damage (cochlea) or injury to the nerve pathways
that relay signals from the inner ear to the brain.
 SNHL in CSOM patients is often demonstrated by higher bone conduction (BC)
thresholds in the audiogram.

BC thresholds in the healthy and CSOM ear differed by at least 20 dB at all of the
measured frequencies.
 Treatment
Combination of aural toilet and topical antimicrobial drops First Line
Otic insufflation powder (chloramphenicol, sulfamethoxazol, and amphotericin B).
Quinolones
Acetic acid, aluminium acetate (Burrows solution), or combinations of these (Domeboros solution),
and iodine-based antiseptic solutions.
Corticosteroid inflammation of external auditoric canal/middle ear mucosa/granulated tissue is
present

Systemic Antimicrobial

Surgery
Mastodidectomy
Tympanoplastyperform from 6-12 months after resolution of the infection
Thank You