Chronic Otitis Media

CSOM
Chronic Otitis Media
COM perforation
COM Perforation

This condition includes all forms of chronic inflammatory conditions of the middle ear that result in permanent changes to the middle ear structures. Basically it signifies a long standing infection of middle ear, which can result in a perforation in tympanic membrane (ear drum), damage to the ossicles (tiny bones of hearing) and involvement of the mastoid bone (bone behind the ear).

There are different types of chronic otitis media depending on the nature of the infection and appearance of the disease.

Active COM where the ear is actively discharging, Inactive COM where the ear does not discharge but has the potential to do so (for example dry perforation) and Healed COM where there is no longer infection and the ear has healed with permanent residual changes (tympano-sclerosis).

Based on the nature of the infection and in some respect the sight of the disease, COM may also be divided into mucosal disease and squamous disease. In the Mucosal COM, the inflammation and infection involved the middle ear mucosa and there is no evidence of squamous epithelium (skin) in the middle ear cleft. This includes simple ear drum perforations. Squamous COM is characterised by the presence squamous epithelium (abnormal skin) in the middle ear cleft and one such type is a cholesteatoma. This is defined as a squamous epithelium lined sack surrounded by granulation that collects keratin debris and has a tendency to expand and destroy bone.

Symptoms includes discharge of mucus or pus, hearing loss and ear discomfort and may lead to serious complications if not treated in time.

Primary treatment options include regular cleaning by syringing or suction clearance under microscope and the application of antibiotic steroid ear drops. While this will control active infection, the changes to the middle ear structures will naturally remain. Activities such as showering and swimming that expose the ear to water will eventually increase the risk of introducing infection.

Surgery to repair the ear drum (myringoplasty or tympanoplasty) may be advised to control recurrent infections. Surgery to repair the ossicles – tiny bone of hearing (ossiculoplasty) may be indicated to restore hearing.

If the infection involves the mastoid bone of the ear, the above operations may have to be combined with a mastoidectomy, which includes opening of the bone behind ear to eventually create a safe ear to prevent complications.

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