Attico- Antral Type ( Chronic Suppurative Otitis Media Squamous)

Subject: Child Health Nursing

Overview

Chronic Suppurative Otitis Media Squamous is a risky or unsafe form of CSOM that is defined by the development of cholesteatoma in the attic antrum, posterior tympanum, and mastoid of the middle ear. Since cholesteatoma shares the same etiology as antticoantral disease, cholesteatoma will be discussed first. Signs and symptoms include ear discharge that is initially sparse and foul-smelling but later becomes moderate to profuse, yellow, purulent, and occasionally blood-stained; hearing loss that is conductive; bleeding; and perforation of the attic or posterolateral superior margin. Its medical treatment involves systemic antibiotic therapy, ear suctioning under microscopic supervision, and antibiotic drop instillation. Atticotomy, modified radical mastoidectomy, and radical mastoidectomy are surgical treatments.

Attico- Antral Type (Chronic Suppurative Otitis Media Squamous)

This chronic infection of the attic antrum, posterior tympanum, and mastoid (the posterior-superior section of the middle ear cleft) is characterized by the development of cholesteatoma, a hazardous or dangerous variety of CSOM.

Causes

The etiology of the antticoantral disease is same as that of cholesteatoma so go through cholesteatoma.

Cholesteatoma

It is known as "skin in the wrong place" because keratinizing squamous epithelium does not normally present in the middle ear cleft. It is defined as the presence of keratinizing squamous epithelium in the middle ear cleft. There are two components to cholesteatoma:

  • The matrix: That is made up of keratinizing squamous epithelium resting on a thin stroma of fibrous tissues.
  • The central white mass: consisting of keratin debris produced by the matrix.

Classification/ Causes of Cholesteatoma

  • Congenital cholesteatoma: It arises from the embryonic cell and rests in the middle ear cleft or temporal bone.
  • Primary acquired cholesteatoma: Retracting pocket formation of pars fluid and collection of desquamated epithelium lead to a formation of cholesteatoma mass.
  • Secondary acquired cholesteatoma: It will be developed by:
    • Migration of squamous epithelium: migration on an invasion of squamous epithelium from a deeper part of the external ear canal and tympanic membrane to the middle ear.
    • Metaplasia: Metaplasia of middle ear mucosa due to repeated infection of middle ear through the pre-existing perforation. Organisms responsible for an atticoantral type of CSOM is same as in turbo tympanic type.
  • Pathological process Includes
    • Cholesteatoma.
    • Osteitis and granulation tissue: A mass of granulation tissue surrounds the area of osteitis and may even fill the attic, antrum, posterior tympanum, and mastoid.
    • Ossicular necrosis: Destruction may involve in stapes superstructure, handle of malleus or the entire ossicular chain result hearing loss.
    • Cholesterol granuloma: it is a mass of granulation tissue with foreign body giant cells surrounding the cholesterol.

Signs and Symptoms

  • Ear discharge: Scanty foul smelling, but later moderate to profuse yellow, purulent, occasionally blood stained.
  • Hearing loss: Conductive hearing loss.
  • Bleeding: It may occur from granulations or the polyp when cleaning the ear.
  • Perforation: Either attic or poster superior marginal type.
  • Retraction pocket: In early stages, a pocket is shallow and self-cleansing but later pocket becomes deep, accumulates keratin mass and gets infected.
  • Cholesteatoma: Pearly white flakes of cholesteatoma mass in the attic or posterior superior quadrant.

Diagnosis

  • History taking.
  • Physical examination.
  • X-ray of mastoid bone (show the extent of bone destruction and degree of mastoid traumatisation).
  • Audiogram.
  • Turning fork test.
  • Pus culture and sensitivity tests to detect organisms.
  • CT scan of temporal bone.
  • MRI.

Treatment

  • Medical Treatment: Careful suctioning of the ear under microscopic guidance, instillation of antibiotics drops and administration of systemic antibiotics.
  • Surgical Treatment: Atticotomy, modified radical mastoidectomy, radical mastoidectomy.
  • Reconstructive surgery: Myringoplasty or tympanoplasty.
Things to remember
  • Chronic Suppurative Otitis Media Squamous is a risky or unsafe form of CSOM that is defined by the development of cholesteatoma in the attic antrum, posterior tympanum, and mastoid of the middle ear.
  • Since cholesteatoma shares the same etiology as antticoantral disease, cholesteatoma will be discussed first.
  • Ear discharge that is first sparse and foul-smelling but subsequently becomes moderate to copious, yellow, purulent, and occasionally blood-stained, hearing loss that is conductive, hemorrhage, perforation of either the attic or poster superior marginal type, and so on are some of the signs and symptoms.
  • Its medical treatment involves systemic antibiotic therapy, ear suctioning under microscopic supervision, and antibiotic drop instillation.
  • Atticotomy, modified radical mastoidectomy, and radical mastoidectomy are surgical treatments.
Questions and Answers

This chronic infection of the attic antrum, posterior tympanum, and mastoid (the posterior-superior part of the middle ear cleft) is characterized by the development of cholesteatoma, an unsafe or dangerous type of CSOM.

Since cholesteatoma shares the same etiology as antticoantral disease, cholesteatoma will be discussed first.

Cholesteatoma

It is known as "skin in the wrong place" because keratinizing squamous epithelium does not normally present in the middle ear cleft. It is defined as the presence of keratinizing squamous epithelium in the middle ear cleft. There are two components to cholesteatoma:

  • The matrix: A thin stroma of fibrous tissues supports the keratinizing squamous epithelium that makes up that.
  • The central white mass: Comprising keratin fragments generated by the matrix.

Signs and symptoms:

  • Ear discharge: Initially pungent, but later becoming mild to profusely yellow, purulent, and occasionally blood stained
  • Hearing loss: Loss of hearing in conductivity
  • Bleeding: Granulations or a polyp during ear cleaning could cause it.
  • Perforation: Superior marginal type in either attic or poster style.
  • Retraction pocket: A pocket is shallow and self-cleaning in the beginning, but as it develops, it becomes deeper, gathers keratin mass, and eventually becomes infected.
  • Cholesteatoma: Cholesteatoma mass with pearly white flakes in the posterior superior quadrant or attic.

Diagnosis:

  • History taking.
  • Examination of the body.
  • Mastoid bone X-ray (show the extent of bone destruction and degree of mastoid traumatisation).
  • Audiogram.
  • Fork-turning test.
  • To find organisms, use pus culture and sensitivity testing.
  • a temporal bone CT scan.
  • MRI.

Treatment:

  • Medical treatment: Carefully suctioning the ear while being inspected under a microscope, applying antibiotic drops, and giving systemic antibiotics
  • Surgical treatment: Modified radical mastoidectomy, radical mastoidectomy, and atticotomy
  • Reconstructive surgery: Tympanoplasty or myringoplasty

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