Complications of csom andha Kumar, 1. Subtitle Complications Of CSOM; 2. Define complication with reference to. Background: Chronic suppurative otitis media (CSOM) is a common public health problem in India. Though there is decline in the incidence of complications but. complications of CSOM however, the rate of complication associated with squamous-type CSOM is still significant in Southeast Asia.1,2 Bezold.
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Durg, Chhattisgarh India.
To determine the incidence of otogenic complications of Chronic suppurative otitis media CSOM and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient.
The data were then compared with the relevant and available literature. Out of these 45 cases, 20 cases had extracranial EC while 25 cases had intracranial IC complications. Ckmplication prevalence of each complication was 0.
The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered.
The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilisPseudomonas aeruginosaStaphylococcus epidermidis were the common organism isolated.
Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was csok modality of management of these conditions.
We observed that two patients fail to regain full facial nerve function despite of surgery. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity.
In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with multidisciplinary approach. Otitis media is common in developing countries among population of low socioeconomic strata. The advent of antibiotics has clearly changed the management of otitis media. Chronic otitis media are potentially serious disease because of their complications.
Common Complications Of Chronic Suppurative Otitis Media(CSOM)! – By Dr. Honey Gupta | Lybrate
In chronic cases complications are usually caused by progressive erosion of the bone thus increasing the risk of damage to facial nerve, labyrinth and the dura. Prior to antibiotic era, intracranial IC complication occurred in 2. With antibiotic and new surgical techniques, the complication have been greatly reduced to 0.
Despite of an overall decline in the incidence of complications of otitis media, life threatening complications still exists. The purpose of this study is to show the prevalence of overall complications of Chronic suppurative otitis media CSOMwarning signs and symptoms, some aspects of causative bacteria and results of treatment.
The objective of the study is to determine various types of otogenic complications affecting both the paediatric and adult population in our institution and efficacy of various clinical measures such as CT scan and culture and sensitivity tests, involved in their diagnosis and management.
Hospital and Research centre, Bhilai, Chhattisgarh. The study includes 45 cases of CSOM with complications. The charts of these patients were reviewed as to their history, clinical finding and investigations, audiological and radiological studies as well as culture and sensitivity tests.
The EC group includes subperiosteal abscess, labyrinthitis, mastoiditis and facial paralysis whereas the IC group included brain abscess, meningitis, lateral sinus thrombosis, extradural and subdural abscess. The prevalence of the EC group was 0. The male to female ratio was found to be 3: The patients included students and housewives.
All patients were of low socioeconomic status and presented with a long standing neglected ear discharge. The common complications in EC group were subperiosteal abscess, labyrinthitis and facial palsy. The subperiosteal abscess was the major co-disease. Brain abscess and meningitis were the two common complications in IC group. Out of 13 cases of Brain abscess, in nine cases it was seen in temporal lobe while in four cases it occurred in cerebellum. Hearing loss assessment showed a conductive hearing loss in 11 cases whereas Sensorineural hearing loss in 28 cases while mixed type hearing loss in 12 cases.
Computed tomography CT scan of Head, Axial view showing a meningeal enhancement b hypodense area c hypodense area with cerebral oedema and d sigmoid sinus enhancement. Computed tomography CT scan Temporal bone, coronal view showing a soft tissue density in right middle ear cavity b erosion of the Tegmen plate.
In the IC group only nine cases showed result, out of which six cases were sterile because patients already received IV antibiotics while rest three patients showed growth of Proteus mirabilis on culture.
In all cases a treatment protocol was followed in our study. The other antibiotics used were inj. Ceftriaxone depending on culture and sensitivity. The most common complication in EC group was subperiosteal abscess.
Most of the cases were children with extensive cholesteatoma, prolonged ear discharge while three cases were with post aural fistula. These cases required premedicated incision and drainage of post aural abscess along with IV multiple dose antibiotics followed by Canal wall down mastoid surgery. The 2nd most common EC complication was labyrinthitis.
These patients required IV multiple dose antibiotics, labyrinthine sedatives, absolute bed rest with canal wall down tympanomastoidectomy with complete removal of the disease cholesteatoma, granulation from middle ear, attic aditus, antrum and mastoid air cell system. The removal of cholesteatoma from fistula site was performed and fistula was sealed. In EC group patient with Facial nerve paresis, surgical intervention at the earliest possible was carried out. Treatment in IC group included multiple high dose parenteral antibiotics, IC drainage and treatment of ear lesion.
In this way the infection process always spreads widely and is very difficult to control if the temporal bone blood supply is cut by early surgical treatment. The ear surgery i. Meningitis is the second most common complication in our series. The lumbar puncture was done carefully.
The radical mastoidectomy was performed in the presence of irreversible pathological changes such as cholesteatoma, granulation and polyp. Simple mastoidectomy was performed in presence of reversible pathological changes such as mild to moderate middle ear mucosa swelling and good aditus drainage. In patients with perisinus abscess and possible lateral sinus thrombosis, aspiration through sinus wall was attempted. If there was no blood, the upper and lower parts of sigmoid sinus were packed tightly with cokplication pack before the wall of the sinus was incised.
In all cases with IC complication, patients were treated with radical mastoidectomy because patients follow up is very poor hence it was tried to give the patient disease free ear in a single setting. Complicarion facial nerve palsy was encountered in seven cases and all of them underwent surgery. Out of seven cases, two had intact ot canal and recovered House brackmann grade 1 postoperatively, while two cases had erosion of horizontal segment of facial nerve with granulation and failed to recover post operatively whereas three patients intraoperatively showed exposed vertical segment of fallopian canal but recovered fully.
The prevalence of CSOM with complication in our series was 0. In Thailand, reports from some centres shows decline in prevalence of complcation complication. The decline could be explained in many ways such as increase in number of ENT surgeons, improvement in standard cxom living and quality of life of the people [ 1 ].
The probable reason why these complication are still encountered may be related to ignorance about the seriousness of persistent and sometimes offensive ear discharge [ 3 ]. The development of subperiosteal abscess with or without fistula leads to reduction of pressure of pus within the middle ear cleft which in turn reduces the chances of infection spreading intracranially.
The mastoid antrum is shallower in younger people. Consequently we found younger patients frequently develop mastoid abscess and post aural fistula than IC complication. The facial nerve palsy in CSOM is associated with dehiscence or destruction of the bony facial canal by cholesteatoma or granulation. Otitic meningitis is the most common IC complication [ 56 ]. It is often associated with brain abscess in our series.
Common Complications Of Chronic Suppurative Otitis Media(CSOM)!
Therefore CT scan is necessary to rule out IC complication. Lateral sinus thrombosis in our series had zero mortality as compared to other series [ 36 — 8 ]. None of the patients in our series received any thrombolytics because of risk of dissemination complicatiob infected thrombus and complciation consequences. Brain abscess is the most common IC complication in our series all are caused by extensive cholesteatoma.
Out of these temporal abscess is most commonly found. Timely intervention along with support of neurosurgery department czom our hospital and proper antibiotic support gave zero mortality as compared to other series [ 369 ].
We suggest that appropriate investigation and early treatment should be made in every patient who presents with fever headache and neck stiffness. Organisms isolated from otorrhoea reasonably reflect the etiological agent of middle ear infection. Proteus mirabilisPseudomonas aerugenosa and Staphylococcus were the most common organisms in our series as in other reports [ cson10 ]. The antibiotics which were based on culture sensitivity report of aural swab and after consultation with our physician played a vital role in good outcome.
Canal wall down mastoidectomy was done in all cases in our series because of extensive cholesteatoma and taking into consideration a possibility of lack of follow up after surgery as most of the patients were from near by village with a poor economic condition making them unable to bear second surgery.
IC drainage should be done first and aural surgery should be scheduled at the earliest safe time during convalescence which is usually several days to weeks [ 11 ]. Management of lateral sinus thrombosis in our series depends on clinical feature of spiky temperature in preoperative period.
We prefer to expose lateral sinus plate in anticipation of an infected thrombus in it. Morbidity in our series is mainly sensorineural hearing loss in The mortality in our series is zero as compared to other series [ 1346 ]. The decreasing mortality in our institution is largely due to modern antibiotic therapy, early diagnosis based on clinical features, CT scan and culture sensitivity and early intervention as and when required.
It is hoped that this study might give some options and awareness to all otorhinolaryngologists that will result in early diagnosis, prompt treatment and further reduction of mortality.
Ashwin Ashok Jaiswal, Email: Praveer Kumar Banerjee, Email: Amrish Kumar Garg, Email: National Center for Biotechnology InformationU. Published online Feb Author information Article notes Copyright and License information Disclaimer. Received Jan 7; Accepted Jan