Clinical and intraoperative findings for dangerous chronic suppurative otitis media in paediatric cases

Abstract

The number of complications in dangerous Chronic Suppurative Otitis Media (CSOM) remain high, especially in late presentation. Extensive disease with intratemporal and intracranial complications, especially in children, was commonly found in Cipto Mangunkusumo General Hospital (CMGH), a tertiary referral hospital. This was a retrospective study that used secondary data from 2017 to 2019 in CMGH. All paediatric patients with diagnoses of dangerous CSOM and who underwent surgery from January 2017 to June 2019 were included. Clinical and intraoperative findings were described in this study. Twenty paediatric patients underwent surgery in CMGH from 2017 to 2019; of that number, 17 had unilateral dangerous CSOM, and three had bilateral dangerous CSOM. All patients aged 2 to 18 years old underwent canal wall down technique surgery. Profound hearing loss was found in nine ears; severe loss, in four ears; moderately severe loss, in four ears; and moderate loss, in seven ears. The most common intraoperative finding was total ossicular destruction in 17/23 ears. Erosion of sigmoid sinus plate was found in 5/23 ears, with perisinus abscess occurring in one case. Tegmen erosion was found in 4/23 ears. Facial nerve dehiscence was found in seven ears (5 vertical segments, 2 horizontal segments) and two patients had facial nerve paralysis before surgery. Lateral semicircular canal (SCC) fistula was found in 6/23 ears. Late presentation in dangerous CSOM can lead to extensive disease and complication, especially in paediatric patients.