CSOM The Hidden Risks of Ear Infections!

Описание: *Chronic Suppurative Otitis Media (CSOM)*

Chronic Suppurative Otitis Media (CSOM) is a persistent infection of the middle ear characterized by ear discharge (otorrhea) and tympanic membrane perforation. It is a common cause of hearing loss, especially in developing countries.

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*Clinical Features*

1. *Persistent Ear Discharge (Otorrhea)*
Painless, continuous, or intermittent discharge from the ear for more than 6 weeks.
The discharge is usually *mucopurulent* (thick and pus-like) and sometimes foul-smelling.

2. *Hearing Loss*
Conductive hearing loss due to tympanic membrane perforation and ossicular chain damage.
Sensorineural hearing loss can occur in complicated cases.

3. *Tympanic Membrane Perforation*
Perforation in the eardrum, which may be *central* (safe type) or *marginal/attic* (unsafe type).

4. *Ear Fullness or Pressure*
Patients may feel a sensation of fullness in the affected ear.

5. *Tinnitus*
Ringing or buzzing sound in the ear in some cases.

6. *Vertigo (Rare in Safe Type)*
Indicates inner ear involvement, often seen in unsafe type (atticoantral disease).

7. *Facial Nerve Weakness (Rare & Serious Sign)*
Suggests complications such as cholesteatoma or intracranial involvement.

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*Diagnosis*

1. *Clinical Examination:*
Otoscopic or otomicroscopic examination reveals a perforated tympanic membrane with mucopurulent discharge.
Marginal perforation or cholesteatoma may be present in the unsafe type.

2. *Pure Tone Audiometry (PTA):*
Conductive hearing loss is typically seen; mixed hearing loss in complicated cases.

3. *Culture & Sensitivity of Ear Discharge:*
Identifies causative bacteria like Pseudomonas aeruginosa*, *Staphylococcus aureus*, or *Proteus species to guide antibiotic therapy.

4. *X-ray Mastoids / HRCT Temporal Bone:*
Done in suspected cholesteatoma cases to assess mastoid involvement.

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*Treatment*

*Medical Management (Conservative Treatment):*
1. *Aural Toilet (Ear Cleaning):*
Frequent cleaning of ear discharge with sterile suction or dry mopping.

2. *Topical Antibiotics:*
Ear drops containing fluoroquinolones (*ciprofloxacin*, *ofloxacin*) are preferred.
*Avoid aminoglycosides (gentamicin, neomycin) if there is a large perforation* to prevent ototoxicity.

3. *Systemic Antibiotics (Oral/IV):*
Used in cases of acute exacerbation or complications.

4. *Nasal Decongestants & Antihistamines:*
Helps reduce Eustachian tube dysfunction.

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*Surgical Treatment (For Non-Healing Cases & Unsafe Type)*
1. *Tympanoplasty (Eardrum Repair):*
Indicated for patients with dry ear (no discharge for at least 6 weeks).

2. *Mastoidectomy:*
Performed in unsafe type (atticoantral disease) or if cholesteatoma is present.

3. *Modified Radical Mastoidectomy (MRM):*
Done in cases with extensive cholesteatoma or complications.

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*Complications (If Left Untreated)*
*Intracranial Complications:* Meningitis, brain abscess, lateral sinus thrombosis.
*Extracranial Complications:* Mastoiditis, facial nerve paralysis, labyrinthitis.
*Permanent Hearing Loss:* Due to ossicular erosion or inner ear damage.

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*Prevention*
Early treatment of acute otitis media.
Avoid inserting foreign objects into the ear.
Maintain ear hygiene and keep the ear dry.
Regular follow-ups for patients with a history of chronic ear infections.

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*Conclusion*
CSOM is a serious middle ear infection that can lead to complications if untreated. Early diagnosis, appropriate antibiotic therapy, and surgery when needed can help prevent hearing loss and complications.