THERAPEUTIC PARTICULARITIES OF CHRONIC SUPPURATED CHOLESTEATOMATOUS OTOMASTOIDITIS

Abstract

Chronic suppurated otomastoiditis is a chronic inflammatory damage of the middle ear and mastoid process that exceeds 12 weeks and which leads to the permanent perforation of the eardrum’s membrane. There is local damage such as osteitis, osteonecrosis and cholesteatoma, while a general view reveals an  asymptomatic evolution, with a good general state, otorrhea being the only local symptom. This paper brings to light a case resulting from the thorough analysis of case studies run by the ENT Clinic of the Emergency County Hospital "Sf. Apostol Andrei” of Galaţi, through the fact that otomastoiditis progresses given the presence of a congenital hemangioma located on the left half of the cephalic extremity, at a cervical, thoracic and abdominal level. The patient, aged 41, has been suffering from this disease since childhood and has undergone numerous surgeries up to this moment, but none has proven to be adequate for the extent of the lesion due to the malformation and the difficulty in providing general anesthesia with orotracheal intubation, the hemangioma being present in the oropharynx, hypopharynx and larynx. Given the overlapping of the two disorders, the surgical-medical approach to the ear damage has proven insufficient in time due to the risk of massive bleeding, taking into account the fact that the hemangioma was extended to the left ear duct, pharynx and larynx. For this reason, the disease has progressed, leading to extended erosive cholesteatoma with left otomastoiditis. The particularities of the therapeutic approach are presented along with anesthesiologic and surgical problems involved by the hemangioma. Although the risk of hemorrhaging was great, approaching the condition by choosing to provide general anesthesia and making the incisions only with the help of an electric scalpel, the case was eventually solved successfully from a surgical point of view.