Description

• Chronic inflammation of the middle ear and mastoid cavity associated with conductive hearing loss and recurrent otorrhea through a defect in the tympanic membrane
• Patient presenting with a history of recurrent ear infection associated with painless discharge from the ear is usually indicative of CSOM

Types of CSOM

Clinically, it is divided into two types:

• Tubotympanic - also called the safe or benign type; it involves anteroinferior part of middle ear cleft, associated with a central perforation
• Atticoantral - also called unsafe or dangerous type; it involves posterosuperior part of the cleft associated with an attic or a marginal perforation

Types

Tubo tympanic type

• Ear discharge- Non offensive, mucoid or mucopurulent, constant or intermittent
• Hearing loss- Conductive type; severity varies but rarely exceeds 50 dB
• Perforation- Always central
• Middle ear mucosa - when inflamed it looks red, oedematous and swollen

Attico antral type

• It involves posterosuperior part of middle ear cleft (attic, antrum, posterior tympanum and mastoid) and is associated with cholesteatoma

Symptoms

• Ear discharge- usually scanty, but always foul-smelling due to bone destruction
• Hearing loss - mostly conductive but sensorineural element may be added
• Bleeding-It may occur from granulations or the polyp

Signs

• Perforation - It is either attic or posterosuperior marginal
• Retraction pocket - an invagination of tympanic membrane is seen in the attic or posterosuperior area of Pars Tensa
• Cholesteatoma - Pearly-white flakes of cholesteatoma can be sucked from the retraction pockets

Investigation

• Usually a clinical diagnosis is made
• Otoscopy – Visible defect of Tympanic membrane
• Tuning fork tests and audiogram
• X-ray: mastoids
• CT scan: temporal bone
• Culture and sensitivity of ear discharge

Treatments

• Aural toilet
• Antibiotic Ear drops
• Systemic antibiotics
• Surgical treatment
  • Canal wall down procedures
  • Canal wall up procedures

Ayurvedic Treatment

• Management of URTI
• Advice to avoid Cold Items

Internal Medicines

For Associated Respiratory tract infections

• Dashamoola katutraya Kashaya
• Vyoshadi vataka

To relieve infection

• Panchathiktaka kashaya
• Guggulu pancha pala choorna
• Kaisora guggulu
• Mahatikthaka gritha
• Guggulu thikthaka gritha

Procedures

• Kabala - Triphala kashaya + Trikatu choorna
• Ear toileting
• Karnadhoopana - Guggulu varthi / Haridra
• Karnapichu - Surasa rasakriya
• Jaloukavacharana over ear
• Sirodhara - Surasadi taila

Department

Salakya - ENT