Study note
ENTCholesteatoma and Chronic Otitis Media

Assessment of CSOM with a central perforation

THE CONTEXT
Assessment uses microscopy, audiometry, microbiological testing and mastoid imaging to evaluate local disease and hearing loss.

Microscopic examination

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Examination under a microscope is essential in every case.
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It assesses granulations, ingrowth of squamous epithelium from perforation edges, the ossicular chain, tympanosclerosis and adhesions.
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An ear that appears dry may contain hidden discharge visible under the microscope.
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Rarely, cholesteatoma can coexist with a central perforation and be detected microscopically.

Hearing and microbiological assessment

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An audiogram assesses the degree and type of hearing loss. The loss is usually conductive, although a sensorineural element may be present.
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Culture and sensitivity testing of ear discharge helps select appropriate antibiotic ear drops.

Imaging findings

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On mastoid X-rays or CT of the temporal bone, the mastoid is usually sclerotic but may be pneumatized with clouding of air cells.
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Bone destruction is absent in the described pattern; its presence is a feature of atticoantral disease.
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