Clinical study of active squamosal chronic otitis media
Keywords:Cholesteatoma, Active squamosal disease, Tympanomastoid exploration, Retraction pocket
Background: Cholesteatoma term was coined by Johannes Muller in 1838. Cholesteatomas are the last stage of squamous epithelial retraction comprising either the pars tensa or flaccida that are not self-cleansing, which retain epithelial debris and elicit a secondary, inflammatory reaction. Active squamosal epithelial disease is a retraction pocket which is filled with keratinous debris.
Methods: 50 patients were selected presenting with active squamosal chronic otitis media (COM). For all cases a detailed history was taken, otoscopic and otomicroscopic examination along with tuning fork test were performed to know the status of tympanic membrane and status of air and bone conduction of sound waves. Audiological assessment was done by pure tone audiometry. X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone was done for analysis. Pre anaesthetic fitness was taken and patients were posted for tympanomastoid exploration.
Results: Most common presentation was of foul smelling otorrhoea in 40 patients, reduced hearing in 40 patients. 8 patients presented with vertigo and 2 presented with facial nerve paresis. Most common otoscopic finding was pf postero-superior retraction pocket in 26 patients. After clinical and radiological assessment 30 patients were posted for canal wall down mastoidectomy.
Conclusions: Primary acquired cholesteatomacan affect all age group with significant effect on hearing and quality of life.
Brown S. Chronic otitis media. Scott Brown’s otorhinolaryngology head & neck surgery Vol-2. Pediatrics the ear skull base, 8th edition. CRC press, Taylor & Francis group, Boca Raton, London, New York. 2018;993.
Brown S. Chronic otitis media. Scott Brown’s otorhinolaryngology head & neck surgery vol-2. Pediatrics the ear skull base; 8th edition. John C Watkinson, Raymond Clark; CRC press, Taylor & Francis group, Boca Raton, London, New York. 2018;981.
Semaan MT, Megerian CA. The pathophysiology of cholesteatoma; OtoLaryngology Clinics of North America. 36th edition. Elsevier Saunders. 2006;1150.
Juhn S, Hamaguchi Y, Goycoolea M. Review of round window membrane permeability. Acta Otolaryngol. 2009;105(457):43-8.
Juhn S, Jung M, Hoffman M. The role of inflammatory mediators in the pathogenesis of otitis media and sequelae. Clin Exp Otorhinlaryngol. 2008;1:117-38.
Kerschner J, Meyer T, Burrows A. Chinchilla middle ear eoithelial mucin gene expression in response to inflammatory cytokines. Arch Otolaryngol Head Neck Surg. 2004;130:1163-7.
Sudhoff H, Tos M. Pathogenesis of attic cholesteatoma: clinical and immunohistochemical support for combination of retraction theory and proliferation theory. Am J Otol. 2000;21:786-92.
Khan MA, Asaduzzaman A, Islam MT, Ahmed B, Hossain MK, Sumon MM, Rabbani S. Clinical Presentation of Cholesteatoma- A Study of 50 Cases. J Armed Forces Med Coll. 2017;13(1):66-70.
Shwetha. Surgical outcome in chronic otitis media with cholesteatoma. Int J Otorhinolaryngol Head Neck Surg. 2018;4:1376-82.
Gaurana JL, Joharjy IA. Middle ear cholesteatoma: characteristic CT findings in 64 patients. Ann Saudi Med. 2004;24(6):442-7.
Shah C, Shah S. Role of HRCT temporal bone in pre-operative evaluation of choesteatoma. Int J Med Sci Public Health. 2014;3:69.
Chan KC, Wang PC, Chen YA, Wu CM. Facial nerve dehiscence in cholesteatoma. Int Adv Otol. 2011;3:311-6.