Suppurative Otitis media (化膿性中耳炎) - Chronic otitis media (慢性中耳炎)

Chronic otitis media (慢性中耳炎)

Aetiology:
Chronic inflammation of the middle ear cleft is usually associated with a perforation of the tympanic membrane. Perforation usually result from previous episodes of acute otitis media when the membrane fails to heal following rupture, but can be due to direct or indirect trauma. In children, perforations can persist following extrusion of ventilation tubes from the tympanic membrane. 

Organism can reach the middle ear from the Eustachian tube or from the external meatus. Chronic middle ear infection is also associated with ossicular damage, with the incudostapedial joint being the most commonly affected linkage.

Clinical features:
A central perforation in the pars tensa part of the membrane is associated with recurrent otorrhoea and conductive deafness. This type of perforation is regarded as safe as neurological complications are rare. An attic or marginal perforation can be associated with the development of a cholesteatoma and is regarded as unsafe.

Management:
Cases of central perforation should be kept dry. If recurrent otorrhoea occurs, ear drops containing a mixture of steroid and antibiotic are used and attention should be paid to possible source of infection in the nasopharynx, nose and paranasal sinuses. A dry perforation can be repaired by myringoplasty. Traumatic central perforations usually heal spontaneously.