Unsafe CSOM (Atticoantral CSOM )
Unsafe CSOM :
Characterized by presence of cholesteatoma ( skin in middle ear cleft ) : Pearly white in colour .
ORIGIN OF CHOLESTEATOMA ::
1) Congenital : Levenson's criteria : i) Pearly white mass behind intact TM ii) There shouldn't be past history of ear surgery iii) There may be past history of ear infection , ear discharge or perforation of tympanic membrane but at present TM is intact.
2) Primary acquired : Due to retraction pocket , lined by skin and filled by keratin
When retraction pocket gets perforated , it forms cholesteatoma . This is the most common origin of cholesteatoma .
Why cholesteatoma is unsafe ? Because of its bone eroding property .
Skin is dangerous when it grows in a closed space which is happening in cholesteatoma .
Bone erosion +
Ossicle erosion +
Granulation formation +
Middle ear polyp formation + Red polyps seen
C/F 1) Ear discharge : Scanty foul smelling and blood stained purulent discharge
2) Hearing loss
Investigation : 1) PTA
2) X Ray mastoid Schuller's view
Treatment of choice : Modified radical mastoidectomy . Main aim is to make the ear safe .
# 3 steps E = Expose the disease
E = Excise
E= Exteriorise the cavity
Done by removing posterior wall of external auditory canal so that mastoid cavity opens into EAC - this will ensure that skin in the middle ear cleft is no longer growing in a close space .
Characterized by presence of cholesteatoma ( skin in middle ear cleft ) : Pearly white in colour .
ORIGIN OF CHOLESTEATOMA ::
1) Congenital : Levenson's criteria : i) Pearly white mass behind intact TM ii) There shouldn't be past history of ear surgery iii) There may be past history of ear infection , ear discharge or perforation of tympanic membrane but at present TM is intact.
2) Primary acquired : Due to retraction pocket , lined by skin and filled by keratin
When retraction pocket gets perforated , it forms cholesteatoma . This is the most common origin of cholesteatoma .
Why cholesteatoma is unsafe ? Because of its bone eroding property .
Skin is dangerous when it grows in a closed space which is happening in cholesteatoma .
Bone erosion +
Ossicle erosion +
Granulation formation +
Middle ear polyp formation + Red polyps seen
C/F 1) Ear discharge : Scanty foul smelling and blood stained purulent discharge
2) Hearing loss
Investigation : 1) PTA
2) X Ray mastoid Schuller's view
 |
| X Ray mastoid Schuller's view |
Treatment of choice : Modified radical mastoidectomy . Main aim is to make the ear safe .
# 3 steps E = Expose the disease
E = Excise
E= Exteriorise the cavity
Done by removing posterior wall of external auditory canal so that mastoid cavity opens into EAC - this will ensure that skin in the middle ear cleft is no longer growing in a close space .
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