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Chronic Ear Disease and Cholesteatoma
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
13 sections · 144 slides
Overview
- Scope of this topic
Defining chronic ear disease
- Definition of chronic ear disease
- Hallmarks of the chronic ear
- Overlapping spectrum of chronic ear disease
- Otitis media and the ex vacuo theory
- Ex vacuo sequence of middle ear disease
- Temporal classification of otitis media
Otitis media with an intact tympanic membrane
- Eustachian tube dilatory dysfunction
- Otitis media with effusion
- Mucosal changes in otitis media with effusion
- Acute otitis media
- Phases of acute otitis media
- Otoscopy of otitis media with an intact drum
Chronic suppurative otitis media
- Natural history of an acute perforation
- Definition of chronic suppurative otitis media
- Otoscopy of chronic suppurative otitis media
- Histopathology of chronic suppurative otitis media
- Remodelling of the middle ear cleft
- Antimicrobial therapy and long-term relapse
- Biofilm persister cells and antibiotic failure
- Traditional subtypes of chronic otitis media
- Limitations of the tubotympanic classification
- Severity grading of chronic ear disease
- Middle ear risk index
- Middle ear risk index (continued)
- Middle ear risk index (continued)
Tympanic membrane atelectasis
- Pathogenesis of tympanic membrane atelectasis
- Consequences of the dimeric drumhead
- Atelectasis with a ventilated middle ear
- Selective epitympanic dysventilation
- Isolated epitympanic retraction and opacification
- Mucosal traction as an alternative mechanism
- Classification of retraction pockets
- Classification of tympanic membrane retractions
- Black classification of eardrum collapse
Risk factors
- Evidence base for risk factors
- Age and Eustachian tube anatomy
- Host and environmental risk factors
- Populations at high risk
Cholesteatoma
- Definition and structure of cholesteatoma
- Matrix and perimatrix
- Cholesteatoma matrix and perimatrix on histology
- Immunogenicity of cholesteatoma keratin
- Aural polyp arising from cholesteatoma
- Absorptive osteitis and bone destruction
- Effect of bacterial superinfection
- EAONO/JOS 2017 consensus
- EAONO/JOS 2017 classification and staging of cholesteatoma
- EAONO/JOS 2017 classification and staging of cholesteatoma (continued)
- Congenital cholesteatoma
- Diagnostic criteria for congenital cholesteatoma
- Origin theories for congenital cholesteatoma
- Theories of acquired cholesteatoma
- Retraction pocket and proliferation theories
- Immigration theory and non-retraction cholesteatoma
- Squamous ingrowth at a pars tensa perforation
- Metaplasia, traction and implantation
Spread of cholesteatoma in the temporal bone
- Sites of origin of retraction pocket cholesteatoma
- Sites of origin of cholesteatoma on the drum
- Determinants of spread in the temporal bone
- STAM subsites of the tympanomastoid space
- STAM subsites of tympanomastoid involvement
- EAONO/JOS staging of cholesteatoma
- Pars flaccida cholesteatoma: primary route
- Inferior extension of pars flaccida disease
- Pars flaccida cholesteatoma, pattern of spread
- Pars flaccida cholesteatoma, later stages of spread
- Anterior pars flaccida cholesteatoma
- Pars tensa cholesteatoma: routes of spread
- Pars tensa cholesteatoma, pattern of spread
- Prognostic contrast between the two types
Microbiology and biofilms
- Limitations of culture and PCR
- Organisms cultured in chronic ear disease
- Less common bacterial isolates
- Nasopharynx as a proposed reservoir
- Fungal infection of the chronic ear
- Tuberculous otitis
- Otoscopic features and treatment of tuberculous otitis
- Biofilms in chronic ear disease
- Mechanisms of biofilm antibiotic resistance
- Implication of biofilms for treatment
Management of chronic suppurative otitis media
- General scheme of management
- Basic medical treatment
- Choice of ototopical agent and ototoxicity
- Response patterns and complication risk
- Indications for surgery in chronic otitis media
- Tympanic membrane repair as mainstay
- Traditional rationale for mastoidectomy
- Evidence against routine mastoidectomy
- Systematic review of therapeutic mastoidectomy
- Limitations of the outcome literature
- Selective indications for mastoidectomy
- Blind sac closure and subtotal petrosectomy
- Hearing rehabilitation after canal closure
Negative middle ear pressure and atelectasis
- Role of Eustachian tube dysfunction
- Rhinologic medical management
- Agents of uncertain or no benefit
- Surgical promotion of middle ear ventilation
- Tympanostomy in the chronic ear
- Surgical decision-making in atelectasis
- Mastoidectomy for negative middle ear pressure
- Evidence for the pressure buffer concept
Management of cholesteatoma
- Indication and goals of cholesteatoma surgery
- Lifestyle considerations in cholesteatoma surgery
- Canal wall-up and combined approach surgery
- Canal wall-down surgery
- Hybrid procedures
- Excision versus exteriorisation of the sac
- Sites of residual and recurrent disease
- Strategies to reduce residual disease
- Strategies for lowering cholesteatoma recidivism
Special situations
- Suspecting underlying systemic disease
- Additional workup in refractory disease
- Eosinophilic otitis media
- Pathogenesis and management of eosinophilic otitis media
- Granular myringitis
- Granular myringitis and canal epithelitis
- Epithelial migration and the role of the malleus
- Consequences of an absent malleus
- Treatment of myringitis
- Summary of key principles
- References
- References (continued)
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- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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