Definition

Otorrhoea of atleast 6 weeks duration in the presence of chronic tympanic membrane perforation (perforation is said to be chronic if present for 3 months).

Risk Factors

•           More siblings under the age of 5

•           Crowded accommodation

•           Prolonged carriage rates of nasopharyngeal pathogens

•           Poorer nutritional status

•           Reduced exposure to medical services and supportive therapies

•           Clinical syndromes like Down syndrome and cleft palate.

•           Clinical Features

•           Muco-purulent ear discharge in perforated TM is profuse.

•           Mild to moderate hearing loss.

•           Itiching and otalgia due to associated involvement of external auditory canal infection by continued and profuse ear discharge causing otitis externa.

•           TM: thick opaque and perforation present in any quadrant.

•           Middle ear mucosa inflammed.

•           Tympanosclerosis and myrnigitis.

•           Lab Investigations

•           Ear swab for culture and sensitivity

•           Microscopic examination

•           Audiological assessment: Pure tone audiometry to asses type and degree of hearing loss Radiological Investigation

•           CT Temporal bone if complications are suspected.

Management

A.  Non Pharmacological

•           Improvement in nutritional status.

•           Improvement in living environment.

•           Education about disease.

•           Keepeardry.

B.  Pharmacological

•           Dry mopping of EAC

•           Aural toilet with suction cleaning.

•           Topical antibiotics- ciprofloxacin, ofloxacin, chioramphenical ear drops.

C.  Surgical

•           Myringoplasty.

•           Tympanoplasty.

•           Canal wall up mastoidectomy: CAT i.e. Combined Approach Tympanoplasty.

•           Canal wall down mastoidectomy:radical or modified