Chronic Otitis Media (Chronic Middle Ear Inflammation)

Chronic otitis media is a condition characterized by persistent or frequently recurring inflammation in the middle ear. Medically complex, it can lead to hearing loss, reduced quality of life, and other serious complications if not treated promptly and properly.

What is Chronic Otitis Media?

The middle ear is an air-filled space located behind the eardrum, consisting of tiny ossicles that transmit sound waves to the inner ear. Chronic otitis media occurs when inflammation in this area persists or recurs frequently. The dysfunction of the Eustachian tube is often a primary cause of this condition. The Eustachian tube is a passage connecting the nose and throat to the middle ear and plays a crucial role in balancing air pressure in the middle ear.

Causes of Eustachian tube blockage include:

• Allergies: Cause nasal congestion and post-nasal drip that affect ear pressure.
• Recurrent infections: Particularly frequent upper respiratory infections during childhood.
• Enlarged adenoids: Can block the Eustachian tube, especially in children.

Symptoms of Chronic Otitis Media

Symptoms of chronic otitis media are typically mild but may worsen over time. The most common symptoms include:

• Ear discharge (yellow or green, foul-smelling)
• Hearing loss
• Fullness in the ear
• Occasional pain or discomfort
• Tinnitus (ringing in the ear)
• Dizziness or balance problems (rarely)

Diagnostic Methods

Accurate diagnosis of chronic otitis media is critical for effective treatment. The methods used for diagnosis include:

Patient’s Medical History

A detailed evaluation of the duration of symptoms, frequency of infections, previous treatments, and other health issues.

Physical Examination

• Otoscopy: Visual examination of the eardrum. Signs such as perforation, fluid accumulation, or abnormal color changes are checked.
• Microscopic Examination: A microscope may be used for a more detailed examination of the eardrum.

Hearing Tests (Audiometry)

As chronic otitis media can lead to hearing loss, hearing tests are performed.

Radiological Imaging

• CT Scan (Computed Tomography): Used to determine if the chronic infection has spread to the mastoid bone or surrounding tissues.
• MR Imaging: Preferred in more complex cases for soft tissue evaluation.

Treatment of Chronic Otitis Media

Treatment varies depending on the cause and severity of the infection. It is generally divided into medical and surgical approaches.

Medical Treatment

• Antibiotics: Oral or local antibiotic drops are prescribed to control the infection.
• Ear Cleaning: Infected fluid and pus in the ear are carefully cleaned by a doctor.

Surgical Interventions

In some cases, medical treatment may not be sufficient. In such situations, surgical methods are employed. Below are the most common surgical interventions for chronic otitis media:

Surgical Interventions and Indications

Myringoplasty

• Indications: Preferred when small perforations are present in the eardrum, but the infection has not spread to the mastoid bone or surrounding structures.
• How It’s Done: The perforation in the eardrum is closed using a tissue graft (cartilage graft).

Tympanoplasty

• Indications: Applied when larger perforations are present in the eardrum or when hearing loss accompanies the condition.
• How It’s Done: The perforations in the eardrum are repaired while also cleaning the middle ear infection and checking the ossicles. If these ossicles are damaged, they may be replaced with a prosthesis or repaired (Ossiculoplasty).

Mastoidectomy

• Indications: Applied in cases where the infection has spread to the mastoid bone or in cases of recurrent infections due to biofilm.
• How It’s Done: The infected portion of the mastoid bone is cleaned. This procedure is often combined with tympanoplasty.

Cholesteatoma Surgery

• Indications: Preferred in cases of cholesteatoma (abnormal tissue accumulation in the middle ear) resulting from chronic otitis media.
• How It’s Done: The cholesteatoma is removed, and all areas where the infection has spread are cleaned.

Success Rates and Risks of Surgical Interventions

Surgical procedures for chronic otitis media generally have high success rates. For example:

• The success rate for tympanoplasty is over 90%.
• The recurrence rate of infection after mastoidectomy is quite low.

However, as with any surgery, there are some risks:

• Hearing loss (rarely)
• Temporary or permanent fullness in the ear
• Recurrence of infection
• Facial nerve paralysis

Conclusion

Chronic otitis media is a condition that can lead to serious complications if not treated promptly. Accurate diagnostic methods and appropriate treatment approaches are critical to controlling the disease. In cases where medical treatment is not sufficient, surgical interventions provide effective solutions. Surgical methods such as myringoplasty, tympanoplasty, and mastoidectomy play an important role in controlling infections and preserving the patient’s hearing health.

Therefore, it is crucial for patients suspected of having chronic otitis media to seek early diagnosis and treatment by an ENT specialist to improve their quality of life.

Cholesteatoma

Cholesteatoma can be simply defined as the abnormal growth of skin in the wrong location. Normally, skin is found in the ear canal and on the outer part of the eardrum. However, when this skin starts growing behind the eardrum or into the bone behind the ear (mastoid bone), it is called cholesteatoma. This abnormal skin grows much faster than normal skin and damages surrounding structures. Cholesteatoma is found in some patients with chronic middle ear inflammation.

Symptoms of Cholesteatoma

The most common symptoms of cholesteatoma are hearing loss and ear discharge. In more severe cases, symptoms such as facial paralysis or vertigo may also occur.

How is Cholesteatoma Diagnosed?

Cholesteatoma diagnosis begins with a thorough evaluation of the patient’s medical history and a physical examination. To confirm the diagnosis and plan treatment, additional tests are typically performed. These tests include hearing tests (audiogram and tympanogram) and a CT scan of the temporal bone (specialized X-ray).

Complications of Cholesteatoma

As cholesteatoma grows, it damages the surrounding bone. This can affect the small ossicles, causing hearing loss. It can also damage the inner ear, leading to total deafness and vertigo. Additionally, it may affect the facial nerve, leading to facial paralysis, or weaken the bone around the brain, causing meningitis. If left untreated, these complications worsen over time.

Treatment of Cholesteatoma

Initial treatment typically involves using antibiotic drops to control the infection. However, the definitive treatment for cholesteatoma is surgical removal. Surgery usually requires making an incision in the ear canal or behind the ear to access the cholesteatoma.

To manage cholesteatoma and repair hearing, a second surgery is often required within 6 to 12 months. If infection is present during the first surgery, hearing restoration is typically done in the second surgery.

The use of otoendoscopy (small angled cameras) during surgery significantly reduces the chances of cholesteatoma recurrence. This technique allows visualization and removal of cholesteatomas in areas that are usually not visible with a microscope.