الفهرس 
Anatomy and Physiology of the EarOnly 14 pages are availabe for public view
 |  | from | 126 |  |  |
| | | from | 126 | | |
Abstract
Chronic suppurative otitis media (CSOM) refers to chronic irreversible inflammatory pathological tissue damage of the middle ear cleft mucosal lining. Middle ear cleft includes the Eustachian tube, tympanic cavity and mastoid air cell system [1]. The incidence and prevalence of CSOM is 65 to 330 million persons and 39 to 20o0 million (60%) of those individuals have clinically significant hearing impairment. Cholestatoma can be either congenital or acquired. The overall incidence is estimated to be around nine per 100000 persons. At least 95%of cholestatoma are acquired. The incidence is similar children and adult. [2]. The CSOM is characterized by recurrent or persistent ear discharge (otorrhoea) over 2-6 weeks through a perforation of the tympanic membrane. Typical findings may also include thickened granular middle ear mucosa, mucosal polyps, and cholesteatoma within the middle ear [3]. The disease often evolves in a continuum. Abnormalities that at first caused mild or minimal symptoms, such as simple retractions, can progress to severe changes, such as retraction pockets and destructive cholesteatomas. The continuum model explains the development of CSOM in a progressive manner. This theory state that effusion, retractions, and cholesteatomas represent different pathological stages of the same disease [4]. The evolution of this continuum can be seen in the contralateral ear (CLE). When tubal dysfunction is the trigger of CSOM, there is a high probability of impairment of both ears although in different intensity. Some studies point to a tendency of bilateral involvement of the middle ear by inflammatory pathologies [5]. The CSOM is differentiated from chronic otitis media (COM) with effusion, in which there is an intact tympanic membrane with fluid in the middle ear but no active infection [6]. Poverty, crowded living conditions due to large families, poor sanitation, and lack of personal and environmental hygiene are some of the main risk factors for the prevalence of the COM. CLE are defined as the asymptomatic ear [7]. The radiological finding of temporal bone in patients with COSM are the presence of non-dependent soft-tissue mass followed by ossicular erosion, scutum erosion, sigmoid sinus plate erosion, labyrinthine fistula, tegmen erosion mastoid cortex erosion. Other finding including mastoiditis with sub-periosteal abscess.[8].