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Ear Pathology Online

Pathology of Otitis Media

Dr Sampurna Roy MD    





Acute otitis media is secondary to an upper respiratory infection, and presents as severe prolonged earache with pyrexia and systemic illness.

In some very acute cases, pus may discharge through a perforation before treatment can be started.  Usually the eardrum is reddened in appearance.

Acute mastoiditis is a serious complication of acute otitis media, but it can be treated successfully in most of the cases with broad spectrum intravenous antibiotics and myringotomy.

Chronic otitis media means that there is a perforation of the eardrum.

If the ear is constantly discharging scanty offensive pus through a posterior or superior perforation (unsafe type), modified radical mastoidectomy may be required, specially if cholesteatoma is present.

A dry central perforation (safe type) which discharge intermittently with colds or swimming, is treated by antibiotic/steroid drops when wet, and may be repaired when dry by grafting of the eardrum if necessary with reconstruction of ossicular chain.

"Glue ear" (seromucinous otitis media), has become an increasingly common disorder in children.

It usually affects those with recurrent otitis media and often enlarged infected adenoids, presumably because of poor Eustachian tube function.

It is specially common in children with cleft palate as the muscles which open the tube have lost their insertion into the middle of the palate and atrophied.

Inadequate antibiotics for acute infections is another possible cause. "Glue ear" is painless, and simply causes conduction deafness, of which it is the commonest cause  in childhood.

In some cases the appearances of the eardrum may be striking and include gross retraction, yellow or grey/blue discoloration  and increased vascularity.

Serous Otitis Media is usually found in adults and, in contrast with 'glue ear', the middle ear effusion is thin and watery.

It causes conduction deafness.

It may result from viral upper respiratory infection or from nasopharyngeal carcinoma (causes of Eustachian tube obstruction), or from barotrauma (sudden change in atmospheric pressure produced by flying or diving).


Further reading:

Acute mastoiditis: increase in the incidence and complications.

Adenoid mast cells and their role in the pathogenesis of otitis media with effusion.

Otitis media with effusion: an effort to understand and clarify the uncertainties.

Otitis media with effusion.

Histopathologic differences due to bacterial species in acute otitis media.

Cytology of middle ear fluid during acute otitis media.

Infiltration of immunocompetent cells in the middle ear during acute otitis media: a temporal study.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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