Chronic mucosal suppuration
| Classification according to ICD-10 | |
|---|---|
| H66.1 | Chronic mesotympanic purulent otitis media |
| ICD-10 online (WHO version 2019) | |
The chronic Schleimhauteiterung of the middle ear ( otitis media chronica mesotympanalis , chronic suppurative otitis media ) is a chronic disease of the middle ear mucosa (chronic) with long-term and / or recurrent inflammation of the middle ear with
- permanent perforation of the eardrum and
- purulent-slimy discharge
goes hand in hand.
Chronic mucosal suppuration must be distinguished from the inflammation caused by a cholesteatoma (chronic bone suppuration).
In chronic mucosal dilatation, the inflammation only affects the mucous membrane of the middle ear, with the exception of the long limb of the incus , bones are not affected. Complications are therefore very rare, and chronic mucosal suppuration can be described as a benign disease.
The chronic mucosal suppuration can result in secretion from the ear for years. However, it can also be inactive for years, in which case there is no secretion, but the eardrum perforation persists. External influences such as an infection of the upper respiratory tract or penetration of water into the ear can then cause the inflammation to flare up again ( exacerbation ). The chronic mucosal suppuration is usually painless.
The cause of the disease is unclear; frequent acute otitis media in childhood, chronic dysfunction of the Eustachian tube , genetic factors and the type of bacterial colonization are assumed to be the cause. Gram- negative bacteria are often found in the middle ear secretion, but it is not clear whether these germs are the cause of the disease or whether they only settle there due to the changed conditions in the middle ear.
Finding
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 . As long as the perforation is small, it is round; larger perforations are kidney-shaped because they leave out the area of the hammer handle. If almost the entire eardrum is missing, one speaks of a subtotal defect. The existing eardrum parts are usually thickened and opaque and may have embedded white, tympanic sclerotic limestone plates.
The middle ear mucosa, which is clearly visible through the perforation, is reddened and swollen ( edematous ) when the inflammation is active . Polyp-like thickening of the middle ear mucosa can reach the level of the ear canal.
The secretion in chronic mucosal suppuration is stringy, slimy or slimy-purulent and odorless.
The hearing ability is impaired to varying degrees by a sound conduction disorder, especially when the ossicular chain is interrupted.
The X-ray findings show an inhibition of pneumatization , i. H. the spaces in the temporal bone connected to the middle ear , especially in the mastoid process, did not develop in childhood. This indicates that the onset of the disease is in childhood.
therapy
Conservative treatment during an inflammatory phase consists of repeated thorough cleaning (rinsing, suctioning) and the introduction of anti-inflammatory and disinfecting or antibiotic substances (drops). However, the success of this treatment is often modest. In particularly stubborn cases, parenteral antibiotic therapy is also performed.
Healing is usually achieved by surgical closure of the eardrum perforation, but the operation should be carried out in the inactive phase if possible.
