Csom (TT)

Chronic Suppurative Otitis
Media (TT Type)

Chronic Suppurative Otitis Media
• Definition:-
Permanent abnormality of pars tensa or
pars flaccida, likely a result of earlier AOM,
negative ET pressure or chronic SOM
characterised by otorrhoea and deafness.
Epidemiology
• Poor SE status, poor nutrition.
• M:F = 1:1 and all age groups.
• Most common cause of deafness in rural
population.
Types of CSOM
• It is divided in 2 types:
- Tubotympanic (safe, benign)
- Atticoantral (unsafe, dangerous)
Difference Bet. TT and AA Type
Tubotympanic Atticoantral
Perforation Central Attic or marginal
Discharge Profuse, mucoid Scanty, purulent and
and odorless foul smelling
Cholesteatoma Absent and Common
or granulation uncommon
Polyp Pale Red and fleshy
Complication Rare Common
Audiogram Mild to moderate Conductive or mixed
Conductive loss loss
Tubotympanic Type CSOM
• Aetiology:-
- Commonly starts in childhood
- Sequel of recurrent AOM or ANOM.
- Ascending infection via ET (tonsillitis, adenoiditis).
- Allergy to dust or foodstuff.
Tubotympanic Type CSOM
• Pathology:-
- Perforation of pars tensa
- Normal or cong., edematous m.e. mucosa
- Pale polyp coming out through perforation
- Perforation is surrounded by a remnant of TM.
- Ossicular chain may be intact or there may be
necrosis of long process of incus.
- Fibrosis or adhesion may be present in m.e..
- Tympanosclerosis.
Tympanosclerosis
• Tympanosclerosis refers to hyaline deposits of
acellular material visible as white plaques in the
TM and as white nodular deposits in submucosal
layers of the middle ear.
• Chalky deposits on TM, middle ear,
epitympanum, ossicular ligament and muscle
tendon.
• Result of healing process in which collagen
hyalinises and loses its structure and forms a
mass which undergo ossification and calcification
leads to tympanosclerosis.
Bacteriology
• Both aerobic and anaerobic organism are involved.
• Aerobic organisms are Ps aeruginosa, Proteus, E.

coli and staph. Aureus.
• Anaerobic organism are Bacteroides fragilis and

anaerobic streptococci.
Clinical Features
• Ear discharge:-
- Intermittent or constant
- Mucoid or mucopurulent
- Odourless
- Profuse or moderate in amount
- Asso. With URTI and water entry in ear
- non blood stained but in granulation tissue or
polyp is formed then blood stained
- Rarely no h/o discharge only deafness is there.
Clinical Features
• Hearing loss:-
- Severity of deafness depends on the following
1. Size of perforation
2. Position of perforation
3. Position of ossicular chain (necrosis or fixation)
4. Status of inner ear
- It is mostly conductive in type and up to 50dB.
- “Round window shielding effect”
- SN loss in long standing case due to absorption
of toxin from oval and round window.
Clinical Features
• Earache:-
- It is present when there is acute exacerbation
of the disease due to URTI.
- It subside as the URTI decresease.
• Headache, vertigo and facial palsy:-
- These are the symptoms of complications
which rarely develops in this type of CSOM.
Clinical Features
• Otoscopy:- There are 2 main things to be
seen in this
1. Perforation:-
- Central or marginal. Ossicular status if seen.
- Different types according to size and position
2. Middle ear mucosa:-
- Normally pale pink, when inflamed it becomes
red, edematous and swollen.
- Polyp may come out through perforation.
• Tuning Fork Tests:- Rinne and Weber test
• Examination of Nose and Throat
Tuning fork test
• RINNE’S TEST becomes negative only if
conductive hearing loss is greater than 15 db.
• WEBER’S TEST becomes lateralised in affected
ear in conductive deafness when hearing loss is 5
db or more.
• If RINNE’S TEST is
- negative with 256,positive with 512 & 1024
20 -30 db deafness.
- negative with 256 & 512 ,positive with 1024
30 – 45 db deafness
- negative with 256,512, 1024 frequency
45 -60 db deafness.
Investigations
• Examination under microscope
• Audiogram
• Culture and sensitivity of ear discharge
• Mastoid x rays
• Routine preoperative major test if surgery
is planned.
Grading of Deafness
• Deafness can be graded into several
categories by air conduction threshold
0 – 25 db = normal hearing level, no deafness
26 – 40 db = mild deafness.
41 – 55 db = moderate deafness.
56 – 70 db = severe deafness.
71 – 90 db = very severe deafness.
Above 90 db = profound deafness
Conservative Treatment
• Aural cleaning
• Topical antibiotics and borospirit
• Systemic antibiotics
• Antihistaminics
• Topical and systemic decongestants
• Analgesics
• Do’s and Don’ts
Surgical management
• Cauterisation (TCA)
• Myringoplasty
• Tympanoplasty
• Cortical Mastoidectomy
• Treatment of precipitating factor

Csom (TT)

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Csom (TT)

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Chronic Suppurative Otitis

Media (TT Type)

• Aerobic organisms are Ps aeruginosa, Proteus, E.

• Anaerobic organism are Bacteroides fragilis and

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