Chronic Suppurative Otitis Media Pathogenesis and Surgical Management with Emphasis on Myringoplasty and Cortical Mastoidectomy

Abstract

Background: Chronic suppurative otitis media )CSOM(  is an inflammation of the middle ear cleft that manifests as recurrent ear discharge that lasts between six weeks and three months and comes from a rupture in the tympanic membrane. Chronic suppurative otitis media can be categorized into two types; benign CSOM (safe type) or commonly called tubo-tympanic type, associated with permanent central perforation, which does not cause serious complications, and malignant CSOM, also called attico-antral type.

Objective: There are a number of studies in the literature highlighting the advantages and disadvantages of performing mastoidectomy in the surgical treatment of mucosal type of chronic otitis media.

Conclusion: Role of mastoidectomy in the repair of tympanic membrane perforation has long been debated. Mastoidectomy was regarded as a means of surgically creating an air reservoir and eradicating sequestered mastoid disease. Myringoplasty is a repair of the perforation of the tympanic membrane. Cortical mastoidectomy involves the eradication of the source of infection in the mastoid and improves pneumatization although it has a risk of squamous epithelium ingrowth, injury to vital structures like facial nerve and inner ear structure. Aeration of the middle ear and pressure regulation is achieved by the mastoid. Mastoid will act as infection nidus if there is a failure to relieve the atticoantral block leading to surgical failure.