Assessment of CSOM: microscopy, hearing tests and imaging

THE CONTEXT

Assessment of chronic middle ear disease establishes the extent of disease, hearing impairment, relevant surgical anatomy and antibiotic selection.

•

All patients with chronic middle ear disease should undergo microscopic examination.

•

Microscopy may reveal cholesteatoma, its site and extent, bone destruction, granuloma, the condition of the ossicles and pockets of discharge.

•

Tuning fork tests and an audiogram are essential before surgery to confirm the degree and type of hearing loss.

•

Mastoid X-rays and CT of the temporal bone indicate the extent of bone destruction and degree of mastoid pneumatization.

•

When surgery on a sclerotic mastoid is contemplated, imaging helps identify a low-lying dura or an anteposed sigmoid sinus.

•

Cholesteatoma causes destruction in the attic and antrum, described as the key area; this is better seen on the lateral X-ray view.

•

CT of the temporal bone provides more information and is preferred to mastoid X-rays.

•

Culture and sensitivity testing of ear discharge helps select an appropriate antibiotic for local or systemic use.

NEETx

Learn. Practise. Remember.