The Surgical Management of Otitis Media

Abstract

Several recent conferences have addressed the issue of defining otitis media. Acute otitis media is an inflammation of the middle ear which may or may not be of infectious origin (infection implies a microbiological etiology). Acute otitis media goes through three clinical phases: sudden onset, full expression, and resolution. When the resolution process extends beyond 3 months, the disease process is arbitrarily designated as "chronic." Between 3 weeks and 3 months, the disease is noted to be in the subacute phase. In acute otitis media, the middle ear mucosa shows extensive leukocytic infiltrates and submucosal edema. Chronic otitis media with effusion includes liquid in the middle ear space. Histopathologically, the middle ear space is characterized by round cell infiltration, extensive fibrosis, proliferation of the mucous membrane, and increased gland formation. The fluid behind the tympanic membrane is either serous (a clear strawcolored effusion), mucoid (a thick, gluelike substance), or purulent (pus). Although in several instances the fluid has a mixed composition with mucoid or purulent features, the physician should, as precisely as possible, categorize the effusion as one type or the other. Recurrent acute otitis media is defined as recurrent inflammation of the middle ear cleft. The disease may show complete resolution between episodes, or manifest incomplete resolution with the presence of an effusion behind the tympanic membrane.