Otitis media - Chronic supporative otitis media

Chronic suppurative otitis media is a perforated tympanic membrane with persistent discharge from the middle ear. Chronic otitis media is the result of an initial episode of acute otitis media. Suppurative otitis media is one of the most common childhood chronic infectious diseases and earache. The episodes of otorrhoea are often provoked by upper respiratory infections. It occurs in the area between the tympanic membrane and the inner ear, including the eustachian tube. Soiling of the middle ear from swimming or bathing also leads to intermittent and unpleasant discharges. The bacteria found infrequently in the skin of the external canal get proliferated in the presence of trauma, inflammation, lacerations or high humidity. These bacteria enter the middle ear through a chronic perforation. The increase occurrence of otitis media in children can be implicated to shorter Eustachian tubes or they have not developed the same resistance to viruses and bacteria as adults. It is primarily a disease of infants and young children, but adult otitis media is also not rare. Otitis media with effusion also called otitis media serosa, refers to the collection of fluid within the middle ear space as a result of the negative pressure produced by altered Eustachian tube function.

Symptoms of otitis media include; earache , a high temperature (fever), being sick, lack of energy and slight deafness. Acute otitis media diagnosis is done by the visualization of the tympanic membrane in combination with the appropriate clinical history. Acute otitis media treatment methods include oral and topical analgesics. They are effective to treat the pain caused by otitis media. Decongestants and antihistamines, either nasal or oral, are not recommended due to the lack of benefit. Management of recurrent acute otitis media includes preventive measures such as immunizations, reduction in exposure to passive smoke, treatment of gastro esophageal reflux. The tympanostomy tube is recommended for chronic otitis media treatment.


Otosclerosis is an abnormal sponge-like bone growth in the middle ear that causes hearing loss. This abnormal growth prevents the ear from vibrating in response to sound waves. Otosclerosis can also affect the other ossicles (malleus and incus) and the otic capsule, the bone that surrounds the inner ear. The hearing loss can be of two types. When otosclerosis involves the small bones of the middle ear, a conductive type loss is found. This type of hearing loss can be corrected both by a hearing aid as well as by surgical procedures called stapedectomy and stapedotomy. When otosclerosis involves otic capsule, a sensory type hearing loss occurs. This type of hearing loss is not correctable by stapedectomy. While hearing aids are usually worth trying, they also may be ineffective. When otosclerosis involves both the small bones and the cochlea, a mixed type hearing loss occurs.

The cause of otosclerosis is unknown. A combination of genetic or viral factors plays an important role in the expression of hearing loss. Otosclerosis is the most frequent cause of middle ear hearing loss in young adults. It typically begins in early to mid-adulthood. It is more common in women than in men. The condition usually affects both ears. Symptoms include; slow hearing loss which worsen later, hearing better in noisy environments than quiet ones, ringing in the ears or tinnitus. Otosclerosis may not require treatment until there is severe hearing problem. Medications such as fluoride, calcium, or vitamin D may help to slow the hearing loss.

Granulation of External Auditory Canal ( E.A.C.)

Otitis externa is an inflammation of the outer ear and auditory canal. The inflammation can be secondary to dermatitis (eczema) only, with no microbial infection, or it can be caused by active bacterial or fungal infection. In either case, the external auditory canal swells and may become painful or tender. The accumulation of granulation tissue involving the floor of the external auditory meatus is another important finding. The accumulated keratin debris traps moisture and results in a bacterial infection of external ear canal and cause ulceration of the epithelial layer and granulation tissue formation in patients with superimposed infection.

Persistent chronic otitis media can cause granulation tissue prolapsing into the ear canal through the TM perforation. Granulation tissue develops in majority of chronic suppurative otitis media. Treatment of granulation tissue involves the use of four modalities: aural toilet, anti-infective, steroids, and cautery or debridement. Biopsy should be considered when granulation tissue is present in external acoustic meatus
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