Presentation
Chronic left ear pain, obstruction and discharge.
Patient Data
Opacification of the left middle ear cleft and mastoid air cells with soft tissue, associated with middle ear atelectasis,
Tympanic membrane thickening and retraction.
No bony erosion. (which differentiates it from cholesteatoma)
Intact scutum, ossicles and tegmen tympani.
Additional examination of the nasopharynx & paranasal sinuses revealed enlarged nasopharyngeal adenoids.
Note the enlarged nasopharyngeal adenoids on the scout
Case Discussion
Chronic otomastoiditis (COM) should be considered a separate entity from acute otomastoiditis, and is thought to be primarily due to Eustachian tube dysfunction as demonstrated in this case secondary to enlarged nasopharyngeal adenoids.
Chronic otomastoiditis (COM) is persistent or recurrent inflammation of the middle ear and mastoid air cells lasting for a minimum of 12 weeks.
The term encompasses a number of conditions:
- middle ear effusion,atelectasis,granulation tissue
- tympanic membrane retraction, thickening, perforation or calcification (myringosclerosis)
- mastoid air cells opacification and sclerosis
- post inflammatory ossicular fixation or noncholesteatomatous ossicular erosion
- cholesterol granuloma or acquired cholesteatoma
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