CHRONIC OTITIS MEDIA – SQUAMOSAL (Unsafe Type)

Chronic otitis media (COM) is a long-standing infection of a part or whole of the middle ear cleft characterized by ear discharge and permanent perforation. The disease involving the posterosuperior portion of the tympanic membrane has a tendency to accumulate cholesteatoma flakes and erode the underlying bones and structures leading to hearing loss and facial nerve palsy. Due to this nature, it is also called unsafe and squamosal disease.

CAUSES:

• Congenital cholesteatoma: It arises from the embryonic epidermal cell rests in the middle ear cleft or temporal bone.

• Acquired cholesteatoma: Blocked ventilation pathways lead to retraction pockets containing cholesteatoma may form in the tympanic membrane. Secondary infection may occur.

SYMPTOMS:

• Ear discharge which is usually scanty, foul-smelling and blood stained. 

• Hearing loss which in some cases, hearing may be close to normal.

• Bleeding may occur from granulations or the polyp when cleaning the ear.

• Other symptoms which may occur include giddiness, facial nerve paralysis and rarely intracranial extension.

SIGNS:

• Perforation in the postero-superior part of tympanic membrane.

• Retraction pocket in the tympanic membrane with or without cholesteatoma flakes. 

INVESTIGATIONS:

• Ear swab to identify the microorganism and the sensitive antibiotic.

• Audiogram to assess the type and severity of hearing loss.

• HRCT of the temporal bone to identify the extent of disease which will help in planning the surgery.

TREATMENT:

Surgery is the preferred to observation due to the bone eroding nature of the disease. Observation is advisable only when there is a shallow self-cleansing retraction pocket with no obvious complications or bony erosions or complications.

The main aim of the surgery is to eliminate the underlying disease, not hearing preservation. The various surgical options available include canal wall down procedures like modified radial mastoidectomy and canal wall up procedures like inside out mastoidectomy, atticotomy. The surgical option will be decided by the surgeon based on the extent of the disease.

Regular postoperative follow-up is required for a period of atleast 10 years.