Chronic otitis media Chunfu dai md ph d Otolaryngology Department Eye Ear Nose and Throat hospital Fudan University
Chronic otitis media Chunfu Dai M.D & Ph. D Otolaryngology Department Eye Ear Nose and Throat Hospital Fudan University
Definition COM: unresolved inflammatory process of the middle ear and mastoid associated with TM perforation, otorrhea and hearing loss
Definition ◼ COM: unresolved inflammatory process of the middle ear and mastoid associated with TM perforation, otorrhea and hearing loss
Etiology Unresolved middle ear infection 1. Uncomplicated inflammatory process of the middle ear may evolve over time to produce persistent effusion and irreversible mucosal change 2. Fluid contains enzymes to alter the mucosal lining of the middle ear, it results in collapse or chronic perforation 3. obstruction of narrow communication between the antrum and the attic the aditus
Etiology ◼ Unresolved middle ear infection. 1. Uncomplicated inflammatory process of the middle ear may evolve over time to produce persistent effusion and irreversible mucosal change 2. Fluid contains enzymes to alter the mucosal lining of the middle ear, it results in collapse or chronic perforation 3. Obstruction of narrow communication between the antrum and the attic, the aditus
Etiology Dysfunction of Eustachian tube Chronic inflammation in nose and pharynx a Dysfunction of immune system
Etiology ◼ Dysfunction of Eustachian tube ◼ Chronic inflammation in nose and pharynx ◼ Dysfunction of immune system
Bacteriology Pseudomonas aeruginosa(40-60%) Staphylococus aureus(10-20%) Anaerobic bacteria
Bacteriology ◼ Pseudomonas aeruginosa (40-60%) ◼ Straphylococus aureus (10-20%) ◼ Anaerobic bacteria
Pathology Middle ear mucosa is lined by secretory epithelium forming glandlike structure u Hyalinization or tympanosclerosis A healing response It occurs during quiescent periods It is formed by fused collagenous fibers It is hardened by the deposition of calcium and phosphate crystals Conductive hearing loss is associated with masses restricting ossicular mobility
Pathology ◼ Middle ear mucosa is lined by secretory epithelium forming glandlike structure. ◼ Hyalinization or tympanosclerosis ◼ A healing response ◼ It occurs during quiescent periods ◼ It is formed by fused collagenous fibers ◼ It is hardened by the deposition of calcium and phosphate crystals ◼ Conductive hearing loss is associated with masses restricting ossicular mobility
Pathology Ossicular erosion is frequent in COM a Infection process per se u Necrosis following vascular thrombosis a It most commonly affect the lenticular process of the incus and head of the stapes
Pathology ◼ Ossicular erosion is frequent in COM ◼ Infection process per se ◼ Necrosis following vascular thrombosis ◼ It most commonly affect the lenticular process of the incus and head of the stapes
Pathology Cholesterol granulomas Presence of yellowish masses surrounded by granulation tissue edematous mucosa and fibrous tissue It contains many cholesterol crystals and foreign body giant cells
Pathology ◼ Cholesterol granulomas ◼ Presence of yellowish masses surrounded by granulation tissue, edematous mucosa and fibrous tissue ◼ It contains many cholesterol crystals and foreign body giant cells
Pathology Cholesteatoma; cystlike, expanding lesions of the temporal bone, lined by stratified epithelium and containing desquamated keratin and purulent material Classification Congenital cholesteatoma Acquired cholesteatoma
Pathology ◼ Cholesteatoma: cystlike, expanding lesions of the temporal bone, lined by stratified epithelium and containing desquamated keratin and purulent material. ◼ Classification ◼ Congenital cholesteatoma ◼ Acquired cholesteatoma
Pathology Mechanics of mucosal transformation and epithelial ingrowth have been the focal point of cholesteatoma Pocket retraction dysfunction of Eustachian tube
Pathology ◼ Mechanics of mucosal transformation and epithelial ingrowth have been the focal point of cholesteatoma ◼ Pocket retraction: dysfunction of Eustachian tube
