There are many ways to classify otitis media, i.e. inflammation of the middle ear mucosa, which is divided into acute and chronic otitis media according to the urgency of onset and clinical characteristics; and non-suppurative (catarrhal) and suppurative according to the different stages of inflammation development. Acute suppurative otitis media is characterized by acute onset, rapid development, severe pain, severe hearing loss and obvious tympanic membrane lesions. The systemic reaction during the suppurative phase is severe.
Chronic suppurative otitis media also has 3 characteristics: ear pus, tympanic membrane perforation and deafness.
In acute and chronic non-suppurative otitis media, the disease is milder than suppurative otitis media and is characterized by tinnitus, deafness, and a sense of ear obstruction. In non-suppurative otitis media, only tympanic membrane invagination is seen in mild cases, while in severe cases, fluid may accumulate in the tympanic chamber. Due to the retention of fibrous exudate in the tympanic chamber, the tympanic membrane becomes invaginated and the auditory chain becomes adherent, resulting in hearing impairment. Therefore, it should be actively prevented and treated at an early stage.
Chronic suppurative otitis media is divided into three types: simple osteochondritis (necrotic type) and cholesteatoma type. Cholesteatoma type otitis media is also called dangerous otitis media, which means that a diagnosis of cholesteatoma type otitis media must be treated surgically, otherwise it is prone to intracranial or extracranial complications, especially intracranial complications such as otogenic meningitis and brain abscess, which may be life-threatening.
The tympanic membrane is perforated in many otitis media, but the tympanic membrane is usually not perforated in the early stages of catarrhal otitis media and acute suppurative otitis media.
1. Simple otitis media
Simple otitis media is the most common type of otitis media with chronic otitis media. It is mostly caused by the invasion of pathogenic bacteria into the tympanic chamber via the eustachian tube during recurrent upper respiratory tract infections, also known as the eustachian tube chamber type. The inflammatory disease is mainly located in the mucosal layer of the tympanic chamber, with congestion and thickening of the tympanic chamber mucosa, round cell infiltration, and active secretion of cupped cells and glands. The clinical features are; ear pus, mostly intermittent, mucopurulent or mucopurulent, and generally not smelly. The amount varies and increases with upper respiratory tract infections. The tympanic membrane perforation is mostly central in the tension department and varies in size, but there are residual tympanic membranes around the perforation.
The tympanic chamber mucosa is pink or pale and may be mildly thickened. The deafness is conductive and usually not severe. Papillary radiographs are often sclerotic without destruction of bone defects. The image on the right shows a centrally perforated tympanic membrane. Simplex otitis media should be treated actively with focal diseases of the upper respiratory tract. Medication is mainly local: aqueous antibiotics or a mixture of antibiotics and steroid hormones, such as 0.25% chloramphenicol solution, chloramphenicol cortisone solution, and oxyfluoxacin ear drops, are available. If the hearing is affected by a large tympanic membrane perforation, tympanic membrane repair or tympanoplasty is feasible about 2 months after the dry ear.
2. Catarrhal otitis media
Catarrhal otitis media is a non-suppurative inflammatory disease caused by obstruction of the eustachian tube and dysfunction of ventilation and drainage. It is a common cause of deafness in pediatric patients and adults. It is also known as exudative otitis media, catarrhal otitis media, plasmacytoid otitis media, plasmacytoid mucus otitis media, and nonsuppurative otitis media. Clinically, there are two types of otitis media: acute and chronic. Acute cicatricial otitis media is often caused by inflammatory obstruction, mechanical obstruction air pressure abrupt change. Chronic otitis media is caused by inappropriate or incomplete treatment of acute otitis media.
The main symptoms in patients with acute catarrhal otitis media are ear congestion, a sense of ear occlusion, tinnitus, and hearing loss, with temporary improvement in hearing when blowing the nose, changing head position, or pulling on the auricle. “Self-hearing enhancement”, the patient has the sensation of hearing their own speech sound particularly louder than usual. Examination: Hearing was conductive deafness with tympanic membrane congestion, invagination, and tympanic chamber effusion. The two pictures on the right side show that there is fluid in the tympanic membrane and the arrow points to the air-fluid surface. The main symptoms of patients with chronic catarrhal otitis media are tinnitus and deafness. Examination of the tympanic membrane is thickened or atrophied, there is calcium deposition, the tympanic membrane is invaginated, and vibration is poor.
3.Osseous otitis media
Osteoclastic otitis media: Also known as necrotic otitis media or granulomatous otitis media, it mostly comes from acute necrotic otitis media. The tissue destruction is extensive and the lesion reaches deep into the bone, and necrosis can occur in the small auditory bone and the tissue around the tympanic sinus; after the mucosal epithelium is destroyed, local granulation tissue or polyps are formed. This type is characterized by persistent ear pus, with blood between the pus and often with a foul odor. Large perforations of the tympanic membrane tension may involve the tympanic ring or marginal perforations.
Its treatment requires active treatment of focal diseases of the upper respiratory tract, such as chronic sinusitis, chronic tonsillitis, and other principles as follows.
(1) For those with unobstructed drainage, local medication is the mainstay, but attention should be paid to regular reexamination.
(2) Middle ear buds can be removed by cautery with 10-20% silver nitrate or scraping with a spoon, and middle ear polyps can be removed with a trap.
(3) In case of poor drainage or suspected complications, modified mastoid radical surgery or mastoid radical surgery should be performed according to the extent of the lesion, and tympanoplasty should be performed at the same time to reconstruct hearing as appropriate.
4.Cholesteatoma otitis media
Cholesteatoma otitis media is not a tumor as it is usually called, but a cystic structure located in the middle ear and mastoid cavity. The inner wall of the capsule is compound squamous epithelium, and the capsule is filled with exfoliated epithelium, keratinized material, and cholesterol crystals, while the outer side of the capsule is closely connected to its adjacent bone wall or tissue by a layer of fibrous tissue of varying thickness. It is called cholesteatoma because of the presence of cholesterol crystals in the cyst.
Cholesteatoma is characterized by the following features: chronic and persistent pus flow from the ear, a peculiar foul odor, and a marginal perforation of the tympanic membrane above the relaxed or tense part (right 3). From the perforation, a grayish-white scaly or pea-like substance is visible in the tympanic chamber, with a strange odor. CT examination can determine the extent of the lesion and guide surgery.
The exact mechanism of cholesteatoma formation is not known. Due to the direct compression of the cholesteatoma or the action of the chemicals it releases, it can destroy the surrounding bone and spread the inflammation, which can lead to a series of intracranial and extracranial complications. Therefore, cholesteatoma-type middle ear must be treated with surgery as early as possible.
The principle of treatment for cholesteatoma middle ear is to perform early modified mastoidectomy or mastoidectomy to completely remove the lesion and prevent complications in order to obtain a dry ear, and to perform tympanoplasty to improve hearing as appropriate.
A cholesteatoma is not really a tumor because it does not contain tumor cells or cancer cells. So why is it called a cholesteatoma? This is because it is round in shape and will grow slowly under certain conditions and can compress the surrounding bone and form a cavity in the mastoid process. It is made up of an accumulation of shed epithelial cells inside and its contents resemble stinky tofu residue and when it is examined under a microscope, there are chemicals of cholesterol crystals, hence the name cholesteatoma.
The formation of cholesteatoma is closely related to chronic suppurative otitis media. When the middle ear is inflamed and pus flows for a long time, the tympanic membrane is corroded by the pus and the perforation becomes bigger and bigger, especially at the edge of the tympanic membrane, and the epidermis of the external ear canal easily enters the middle ear cavity and the mastoid cavity along the perforation. As the epithelial layer of the epidermis becomes keratinized, it is repeatedly shed, and over time, it accumulates like a snowball, becoming larger and larger, compressing the surrounding bone and causing it to absorb into the cavity.
In addition to the corrupting effect of bacteria, it can produce lactic acid, which further corrodes the surrounding bones and spreads the inflammation to the surrounding tissues. …… The places where cholesteatoma is likely to occur are middle ear and mastoid, which are surrounded by important organs, such as brain, cerebellum, large blood vessels, facial nerve and auditory nerve. Especially close to the cranial cavity, there is only a thin layer of bone plate separating them. As the cholesteatoma body for the break increases, the pressure increases and the compressed bone plate is separated. As the cholesteatoma body for the break increases, the pressure increases and the compressed bone is absorbed and the cavity expands. Once the bone wall is punctured, pus and bacteria can enter the skull through this and serious intracranial complications can occur, such as dural abscess, sigmoid sinus thrombophlebitis, septic meningitis and brain abscess. If left untreated, the development can be life-threatening.
Patients with cholesteatoma otitis media, regardless of the size of the cholesteatoma, have a time bomb planted in their bodies that will explode sooner or later. The more frequent the acute attacks, the faster the growth rate of the tumor, and the closer the time of explosion. Therefore, when a patient with otitis media formed by cholesteatoma is found, the doctor always advises the patient to have an early surgery to dig out this time bomb.