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This research paper investigates the incidence, clinical presentations, and management of complications associated with squamosal type chronic otitis media (csom) in a tertiary care center. The study analyzes data from 25 patients, highlighting the prevalence of complications like brain abscess and mastoid abscess. It emphasizes the importance of early diagnosis and treatment to prevent severe consequences. The paper also discusses the role of antibiotics and surgical interventions in managing csom complications.
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Department of ENT and Head and Neck Surgery, Assam
International Journal of Otorhinolaryngology and Head and Neck Surgery | December
2022
Dr Vinisha Wilson
(Pg 1
st
year )
Resident in ENT
Date 23/1/
Chronic otitis media is inflammation of the middle ear
cleft marked by persistent discharge and perforation of
tympanic membrane.
Chronic otitis media of squamosal type is inflammation
of the middle ear cleft which can occur as a sequelae of
acute otitis media or eustachian tube dysfunction and
retraction pocket formation in the attic, the pathogenesis
of which may begin in childhood as a spontaneous
tympanic membrane perforation.
Habermann gave the theory of migration, wich states
that keratinizing squamous epithelium of tympanic
membrane or deep canal wall migrates into the middle
ear through a pre-existing tympanic membrane
perforation, leading to secondary acquired
cholesteatoma.
Basal cell hyperplasia theory was given by Lange and
Ruedi and it explains that disruption of the basal lamina
allows invasion of epithelial cones into the subepithelial
connective tissue and forms micro-cholesteatomas,
which enlarge,
perforate the tympanic membrane and forms primary
cholesteatoma.
and Sade states that metaplasia of the middle ear
mucosa into squamous epithelium due to repeated
infection through a pre-existing perforation causes
secondary acquired cholesteatoma.
An extensive form of the disease can be seen ranging
from mild otorrhea to severe life-threatening
complications which are due to progressive erosion of
bone, retrograde thrombophlebitis of veins,
periarteriolar
space of Virchow and Robin, preformed pathways and
hematogenous spread.
Complications of chronic otitis media can be broadly
classified into intracranial and extracranial.
Intracranial
ones are extradural abscess, subdural abscess, brain
abscess, lateral sinus thrombophlebitis, meningitis
and
otitic hydrocephalus.
Extracranial complications can
further be classified into intra-temporal and extra-
METHODS
This is a hospital-based prospective observational study.
A total of 25 (n) patients with chronic otitis media of
atticoantral type were admitted in the department of
otorhinolaryngology and head and neck surgery in
AMCH, a tertiary care centre, who underwent HRCT
temporal bone followed by surgical intervention from
January 2021 to December 2021 and were included in the
study. Study approved by institutional ethics committee.
diagnosed with unsafe variety of chronic otitis media
with or without complications and patients giving consent
to participate in the study; and exclusion criteria are those
with congenital ear disease, malignant ear pathology, safe
CSOM and not giving consent to participate in study.
Statistical analysis
The data collected were tabulated in Microsoft Excel
Worksheet.
proportions and percentages.
Methodology used
The study was carried out by taking a thorough history
from the patients who were admitted in the department of
ENT and Head and Neck surgery, AMCH to determine
the duration and type of discharge, hearing loss or any
other complain.
The demographic profile of the patients
were analysed and general examination done.
Otoendoscopy was done along with nose and throat
examination.
Systemic examination was done with
emphasis on CNS examination.
In cases with signs of intracranial complications,
fundoscopy was done to rule out papilloedema and CT
brain done.
complications, except sigmoid sinus thrombosis, were
managed initially by neuro-surgeons and neurologists and
then patients underwent mastoid exploration for complete
eradication of disease.
precautions, mastoid surgery was performed under
general anaesthesia.
Twenty patients were approached by
classical post-auricular approach to mastoidectomy, while
5 patients approached endo-scopically.
All patients of unsafe variety of chronic otitis media
attending otorhinolaryngology department during the
study period who fulfil inclusion criteria were
included in study.
period. Most of the cases were found in age group of
11 to 30 years (Table 1).
The number of cases were higher in
males with 60% cases in comparison to females
which was 40% cases. Male to female ratio was 1.5:
(Table 2).
Figure 1 shows the various clinical presentations of
patients with the most common being otorrhea.
Majority of the
patients showing
complications were
in
the age group of 11-
20 years (Table 4).
Intraoperatively,
either
cholesteatoma or
granulation tissue or
both were
found with highest
incidence of
cholesteatoma alone
(Table 5).
Age and gender distribution
In our study, the patients were in the
range of 8-53 years
with a mean age of (20.64±9.66) years
and the male to
female ratio was 1.5:1, which were
similar to a study by
Basak et al where the average age was
estimated to be
(25.87±12.29) years and the male:
female ratio was 1.46.
It was also in accordance to a study by
Verma et al.
Neck rigidity,
Kernig’s sign and Brudzinski sign (8%) were seen
in 1
case of meningitis and temporoparietal abscess
each.
closure was seen in the case of lower motor
neuron
facial nerve palsy (4%).
patient presented with fever, sensorineural hearing
loss, dizziness and nystagmus and fistula test was
found to be positive.
in the ampullary end of lateral semi-circular canal.
Complications
The 25 cases were taken in our study of which 9 had
complications and 16 were without any complications.
Nine of 25 patients presented with complications of
chronic otitis media. We have encountered multiple
complications (both intracranial and extracranial)
numbering to 13, in those 9 patients. 2 patients had only
intracranial and 3 had only extracranial complications.
Remaining patients presented with more than 1
complications.
