Published: 2021-06-23

Spectrum of clinical characteristics of chronic suppurative otitis media unsafe type: a retrospective study from a tertiary care teaching hospital in Central India

Rashmi Hansdah, Kavita Sachdeva


Background: Chronic suppurative otitis media (CSOM)-unsafe type or atticoantral disease or chronic otitis media-squamosal type is a commonly encountered bone eroding disease of the middle ear whose complications can be potentially fatal.

Methods: Retrospective analysis of 80 patients who underwent mastoid exploration in the department of otolaryngology and head and neck surgery, NSCBMCH, Jabalpur between June 2016 and May 2017.

Results: Unsafe CSOM is commoner in young males of 16-30-year age group. Foul smelling, scanty, purulent ear discharge was the commonest symptom (97.5%). Attic perforation was the most consistent otoscopic finding (47.5% cases). 15% of our patients had central perforations. Conductive hearing loss was most common (62%) followed by mixed hearing loss (23%) and sensorineural hearing loss (11%). Commonest complication encountered was mastoiditis (27 cases). Mastoidectomy with tympanoplasty was done in almost all cases (97.5%). Attic (96.2%), additus (90%), and antrum (86.2%) were commonly involved by disease process. Incus was found to be most susceptible to erosion (88.5%) while stapes was most resistant (36.25%).

Conclusions: Unsafe CSOM presenting late warrant prompt diagnosis and surgical intervention. Unusual presentation like retropharyngeal abscess and trismus should raise suspicion of complicated unsafe CSOM in patients with history of otorrhoea. Canal wall down mastoidectomy with rehabilitation of hearing is the surgery of choice in patients who are unlikely to follow up regularly.


Unsafe CSOM, Atticoantral disease, Chronic otitis media squamosal type, Retropharyngeal abscess, Mastoidectomy

Full Text:



Navaneethan N, YaadhavaKrishnan RD, Muthukumar U, Harihara R. Our experience of unsafe ear. Indian J Otol. 2015;21:37-40.

Sade J, Berco E, Buyanover D, Brown M. Ossicular damage in chronic middle ear inflammation. Acta Otolaryngol. 1981;92:273-83.

Varshney S, Nangia A, Bist SS, Singh RK, Gupta N, Bhagat S. Ossicular Chain Status in Chronic Suppurative Otitis Media in Adults Indian J Otolaryngol Head Neck Surg. 2010;62(4):421-6.

Khan MF, Khan AU, Iqbal J, Amjad M. Ossicular changes in choroni9c suppurative otitis media. Atticoantral Dise Ann KE Med Coll. 2006;12(3);396.

Aberg B, Westin T, Tjellstrom A, Edstrom S. Clinical characteristics of cholesteatoma; Am J Otoloryngol. 2013;12:254-8.

Vartiainen E. Changes in the clinical presentation of chronic otitis media from the 1970s to the 1990s. J Laryngol Otol. 1998;112:1034-137.

Khemani A, Akhund AA, Shakh AB. Bacteriology and its effects on clinical presentation and treatment results of chronic suppurative otitis media (CSOM). Med Channel 1999; 5(1):35-8.

Martins O, Victor J, Selesnick S. The relationship between individual ossicular status and conductive hearing loss in cholesteatoma. Otol Neurotol 2012;33(3):387-92.

Pal MB, Khan N; Incidence of complications in temporal bone due to cholesteatoma. Pak Postgrad Med J. 1995;10(4):109-11.

Kartush JM. Ossicular chain reconstruction. Capitulum to malleus. Otolaryngol Clin North Am. 1995;27:689-715.

Garap JP, Siba P. Dubey Canal-Down Mastoidectomy: Experience in 81 Cases. Otol Neurotol. 2001;22:451-6.

Kurien M, Job A, Mathew J. Otogenic intracranial abscess: concurrent craniotomy and mastoidectomy: changing trends in a developing country. Arch Otolaryngol Head Neck Surg. 1998;124:1353-64.