Clinicopathological correlation in Chronic Suppurative Otitis Media MC01-MC04
Dr. Yadlapalli Ajay Kumar,
Associate Professor, Department of ENT, GSL Medical College, Rajamahendravaram-533296, Andhra Pradesh, India.
Introduction: Chronic Suppurative Otitis Media (CSOM) is one of the main causes for preventable hearing loss and is characterised by permanent perforation of tympanic membrane and ear discharge. Observing histopathological changes in middle ear and mastoid in CSOM can help in planning the surgical procedure and outcome of the disease.
Aim: To study the relationship between various clinical features of CSOM and the histopathological findings and to study if this relationship helps in assessing the treatment protocol and surgical planning of the cases.
Materials and Methods: The procedures followed were in accordance with the ethical standards of the Institutional Ethical Committee and with the Helsinki Declaration of 1975 that was revised in 2000. After obtaining informed and written consent regarding their willingness to participate in the study, patients of CSOM were taken for the study. CSOM was diagnosed after eliciting proper history, thorough clinical examination and after performing relevant investigations. Mucosa of middle ear was obtained from all such cases and sent for histopathological examination. The surgical patients were followed up every week for three weeks, fortnightly for the next month and monthly for the next six months. The patients were examined for any aural discharge, during their postoperative follow up, the condition of the graft was assessed and PTA for hearing evaluation was done after a month. Inclusion criteria : CSOM patients attending ENT Outpatient Department (OPD) or admitted in ward, with a willingness to participate and on regular followup for six months. Exclusion criteria : Patients not willing to participate in the study, with uncontrolled systemic diseases, and with predisposing factors and who missed the postoperative follow up.
Results: Histopathological examination of the cases showed changes corresponding to chronic inflammation with lymphoplasmacytic infiltrations in most of the cases, with few cases showing granulation tissue. Patients with granulation tissue are associated with ossicular necrosis.
Conclusion: The present study helps in comprehensive management of CSOM considering the various clinical and pathological features. Amount of hearing loss is correlated with the size of perforation. Granulation tissue is associated with mucopurulent discharge. Ossicular necrosis is seen in 50% of cases with granulation tissue. The study helps in better understanding of clinical and pathological course of CSOM and helps in rationalising the treatment protocol and in surgical planning.