Chronic suppurative otitis media attico - antral type in the present era: an overview

Introduction: Chronic suppurative Otitis media is the result of an initial episode of Otitis media and is characterised by a persistent discharge from the middle ear through a tympanic membrane perforation. It is an important cause of preventable hearing loss, particularly in the developing world. Chronic suppurative Otitis media is usually classified into two main types-tub tympanic and Attico-antal diseases. Tubotympanic type is characterised by a perforation in the pars tensa and is generally called safe type of CSOM. The Attico antral type is called unsafe or dangerous type because of the associated complications which may be life threading at times. These complications are mainly due to granulation tissue and cholesteatoma causing bone erosion and necrosis which may involve vital structures such as facial nerve, inner ear and intra cranial components.
Material Methods: This prospective study was conducted in the Department of ENT Head and Neck Surgery SKIMS MCH Bemina Srinagar J & K on 360 patients of CSOM over a period of 5 years. The details of clinical examination, routine investigations, audiometry, examination under microscope and findings of HRCT temporal bone were recorded. The following criteria were used for including the patients in study.1.Patients of either sex, aged ˂ 70 years.2. Patients having following findings on clinical records (a) Central Perforation. (b) Marginal / Attic Perforation.(c) Retraction Pocket (d)Erosion of outer attic wall.(e)Presence of cholesteatoma, Granulation tissue and or Aural polyps. 3.Healthy patients without any intracranial complications. As per operation records in the patients with dry central perforation were managed with tympnoplasty and patients having CSOM with active mucosal disease were managed with cortical mastoidectomy with tympanoplasty. The patients with Retraction pockets, cholesteatoma, were managed with modified radical mastoidectomy with tympanoplasty.
Results: There were 360 patients, 130 (36.1 %) were males and 230 (63.9 %) were females. The age of the patients ranged from 8-65 years with majority 128 (35.5%) being between 21-30 years of age. The youngest patient was 8 years old and the oldest patient was 65 years of age. Most of the patients had unilateral disease 302 (83.9%) Table 1. Central perforation was noted in 266 (73.9 %) cases, marginal or attic perforation in 73 (20.3%) cases, retraction pocket in 55 (15.3 %) cases, erosion of outer attic wall in 89 ( 24.7%) cases, cholesteatoma flakes in 81 (22.5%) cases, granulation tissue in 33 (9.16%) cases and aural polyps in 29 (8.05% ) cases were seen in CSOM Table 2. Ossicular damage was observed in all cases having unsafe CSOM, Incus was the most commonly damaged ossicle and were seen in 52 (55.3%) cases, followed by Malleus in 41 (43.6%) cases, stapes in 18 (19.14 %) cases and absent ossicles in 8 (8.5 %) of cases Table 3.Most of the cases 334 (92.8%) had conductive hearing loss and 26 (7.2 %) had mixed hearing loss. Tympanoplasty was done in 206 (57.2 %) of patients, cortical mastoidectomy and Tympanoplasty in 60 (16.7 %) of patients and Modified Radical Mastoidectomy with tympanoplasty in 94 (26.1%) of patients.
Conclusion: Despite effective antibiotics, trained manpower, adequate facilities unsafe CSOM continues to affect a sizeable fraction of population in developing countries. A lot of stress needs to be put on early reorganisation of the disease, as patients diagnosed early have less ossicular damage/ complications as compared to those who seek medical advice at an advanced stage of disease.