Chronic otitis media

Otite moyenne chronique

These are all inflammatory or infectious processes of the middle ear operating in a chronic fashion.

Mucosal chronic otitis media are benign principle, chronic otitis media cholesteatoma are dangerous and require surgical treatment.

Different etiological factors: inflammation and chronic obstruction of the upper airway maintaining inflammation of the Eustachian tube, local land fragility.

1- Simple chronic ear infections:

MUCOSAL EAR INFECTIONS:

A- Otitis media with effusion closed eardrum:

-> Child between 3 and 8 years (4%). Rare in adults (nasopharyngeal cancer?).

-> Diagnostics on the hearing loss in children behind in school.

-> Otoscopy: Matt eardrum slightly retracted, amber (yellow brown).

-> Deafness variable transmission 2O to 4O dB. Tympanogram flat impedance measurement.

-> Variable Evolution:

* Spontaneous recovery in the summer,

* Persistent deafness and educational backwardness,

* Retraction pocket and ossicular lysis and cholesteatoma.

-> Treatment:

* Recent stage serous: antibiotics and corticosteroids, paracentesis and suction removal of vegetation;

* Mucous stage tiller deafness .Treatment additional ventilation tubes: Processing of the ground, spa treatments do not prevent frequent recurrences (3O% of cases).

B- Otitis mucosa open eardrum:

* Otitis mucosa open eardrum or tubal otorrhea has a generally bilateral otorrhea, mucous or mucopurulent.The tympanic perforation is earlier, or anterior inferior, or total.

* The role of the nasopharynx or the land is predominant and evolution is often very slow until the age of 8 years or puberty.

* Treatment is medical (removal of the adenoids, vaccine therapy, spa therapy). Never instill ototoxic drops.

* The tympanic perforation sequelae (acute necrotizing otitis after for example) can always secondary infection (swimming, push nasopharyngeal).

* Changes to tympanosclerosis possible, ossicular lysis possible, can epidermal pass.

* The treatment is preventative (abstention bathing) or surgery (tympanoplasty).

2- Cholesteatomatous chronicles:

The keratinizing squamous epithelium of the eardrum and the conduit enters the middle ear to the favor of a retraction of the membrane Shrapnell or pars tense, or by direct epidermal migration. Some congenital cholesteatoma of the anterior-superior fund exist in young children.

Diagnosis: hearing loss and especially fetid purulent otorrhea, sometimes complications.

Otoscopy: Marginal perforation (Shrapnell, Posterior region of the body which is actually the collar of a pocket full of cholesteatoma).

Search a sign of the fistula to the pneumatic test.

TDM to specify the extension.

Surgical treatment combining excision and tympanoplasty; often nécessaire.Surveillance second time control for the very long term as possible recurrence.