Chronic otitis media
| Classification according to ICD-10 | |
|---|---|
| H65.2 | Chronic serous otitis media |
| H65.3 | Chronic mucous otitis media |
| H65.4 | Other chronic otitis media |
| H66.1 | Chronic mesotympanic purulent otitis media |
| H66.2 | Chronic epitympanal otitis media |
| H66.3 | Other chronic purulent otitis media |
| ICD-10 online (WHO version 2019) | |
The term chronic otitis media includes two chronic diseases of the middle ear, chronic suppuration of the mucous membrane and chronic suppuration of bones . Both diseases are associated with recurring or long-lasting (chronic) inflammation of the middle ear with permanent eardrum perforation and purulent discharge, but apart from that, they have little in common.
- In chronic mesotympanic mucosal dilatation (otitis media chronica mesotympanalis, chronic suppurative otitis media), chronic mesotympanic otitis , the inflammation only affects the mucous membrane of the middle ear, with the exception of the long limb of the anvil, bones are not affected. The eardrum perforation is in the chronic mucosal dilatation in the tight part of the eardrum ( pars tensa ), a border of the eardrum always remains at the edge. This perforation is therefore referred to as the central perforation. The perforation can be small and round, larger perforations are kidney-shaped because the area of the hammer handle is left out. If almost the entire eardrum is missing, one speaks of a subtotal defect. The secretion in chronic mucosal suppuration is stringy, slimy or slimy-purulent and odorless.
- Chronic bone suppuration, chronic epitympanal otitis media , is caused by a cholesteatoma . In the case of cholesteatoma, the eardrum perforation is mostly simulated by the keratinizing epithelium that grows into the middle ear like a sac from the eardrum . This perforation is at the edge , it extends to the bony edge of the eardrum, there is no edge of the eardrum. The perforation is particularly common in the uppermost, thin part of the eardrum, the pars flaccida . The secretion in chronic bone suppuration is creamy-yellow and disgustingly smelly (fetid). In the case of chronic bone augmentation, the ossicles and the bones adjacent to the middle ear can be destroyed and severe, even life-threatening complications can occur.
The cause of both forms of chronic otitis media has not been clearly established. Frequent acute otitis media in childhood, chronic malfunction of the Eustachian tube , genetic factors and the type of bacterial colonization are assumed to be the cause.
Both forms of chronic otitis media do not heal spontaneously. Chronic mucosal suppuration is usually harmless and can be inactive for years. Surgical closure of the eardrum can end the disease. Due to the possibility of dangerous complications, chronic bone augmentation is a clear (absolute) indication for surgery.
