Chronic otitis media
Otitis media is defined as an inflammation of the middle ear cleft without reference to etiology or pathogenesis. Sources of infection in Otitis media are mainly dependent on the route by which infection reaches the middle ear. The chief route by which this occurs is the Eustachian tube.7, 8 .The causative infections may be in the nose, paranasal sinuses or in the oropharynx. All these conditions are ascending infections of Eustachian tube 9.
The acute phase of Otitis media is considered to be the initial 3 weeks of inflammation, chronic phase 3 months, following onset of inflammation and Sub acute phase is said to be between 3 weeks and 3 months10. Chronic otitis media is a major cause of hearing impairment which may lead to cognitive, language and auditory defects. The prevalence of chronic otitis media in Indian
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Tubo tympanic type is otherwise called safe type or benign type, because it is not associated with any serious complications. This form of disease is characterized by a perforation of pars tensa in which the margins of the perforation are surrounded by a rim of pars tense or annulus. Disease in the middle ear cleft is confined to the mucosa and it is rarely the seat of complications. Clinically tubo-tympanic disease can be found with 3 presentations, VIZ (A) Tympanic membrane perforation which is noted on routine physical examination and patient is completely asymptomatic I.e. inactive. (B) There is intermittent otorrhoea that readily responds to treatment. (C) There is intractable drainage that resists all conservative management. In these cases florid granulation tissue occupies entire middle ear cleft. In some cases if left untreated the hyperemic mucosa may coalesce to form a polyp which may protrude into the external auditory