Chronic Otitis Media Surgery

What causes chronic otitis media?

All forms of chronic otitis media are consistently caused by Eustachian tube dysfunction. This tube connects the nasal cavity to the middle ear, ensuring its ventilation. Normally, it opens every 5 minutes while awake and every 10 minutes while asleep, allowing air circulation. Most people don't notice this, but it's crucial. We become aware of it when experiencing pressure changes, such as during ascents/descents, air travel, or scuba diving. These situations highlight the tube's role in equalizing ear and external pressure. Manually forcing the tube open by closing the nose and blowing is sometimes possible (a compensation maneuver used by divers). Disruption to this opening mechanism is fundamental to chronic otitis media.

What happens if the auditory tube doesn't work?

First phase of otitis: acute otitis media

Eustachian tube dysfunction underlies chronic otitis media. Within 24 hours of obstruction, ear pressure drops rapidly. Over time, this "vacuum" draws fluid from the ear's mucosal capillaries. Serous fluid accumulates, hindering eardrum and ossicular chain movement, causing deafness. Initially, there's no pain. If the condition stops here, it's seromucous otitis, common in children. If bacteria infect the fluid, turning it to pus, intense pulsating pain begins – acute otitis media.

Acute otitis media is like a large pimple forming in the ear. Pus accumulates, pressing on the eardrum until it ruptures (after 2-3 days), releasing the pus and relieving pain and fever. The eardrum usually heals, provided the Eustachian tube functions correctly.

From acute otitis media to chronic otitis media

Prolonged dysfunction prevents healing; discharge continues for weeks. The eardrum may not heal, resulting in a persistent perforation, ranging from small to total destruction – chronic otitis media. Healing is impossible; the damage is irreversible. Persistent nasal issues causing tube obstruction lead to recurring pus discharge (otorrhea). Water entering a perforated ear also causes prolonged discharge. These relapses damage delicate middle ear structures.

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Detecting chronic otitis media

ENT specialists must determine if the underlying nasal issue persists. Middle ear reconstruction fails without proper Eustachian tube function. Therefore, endoscopy, CT scans of the paranasal sinuses, and potentially nasal surgery are common.

Treatment of chronic otitis media

Chronic otitis media with perforation of the membrane

This often involves eardrum perforation and ossicular chain damage. Tympanoplasty reconstructs the eardrum (often in stages), followed by ossicular chain reconstruction after at least 6 months.

Chronic otitis media without perforation of the tympanic membrane

This progresses from seromucous otitis to tympanosclerosis. Childhood seromucous otitis is treated with adenoidectomy and transtympanic drainage. Tympanosclerosis is challenging; surgery is often avoided. Repairing the sclerotic chain rarely provides lasting results, and surgery risks inner ear damage and sensorineural deafness, worsening the patient's hearing loss.

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