Description
Case I
Case II
Case III


Description 

Otitis media with effusion is defined as the presence of mucoid or serous fluid in the middle ear. There are no signs or symptoms of acute infection. Long lasting, untreated chronic otitis media may cause damage of the tympanic membrane, ossicles and can also lead to development of cholesteatoma.


Case I

Picture below: this is a picture of the advanced, late stage, 12-year-old child, left ear. The tympanic membrane is evidently pulled in the posterior quadrants. The tympanic cavity is filled with a serous fluid. Typical air-fluid level is visible as a thin line below undamaged anterior fragment of the tympanic membrane. The handle of the malleus is protruding and well visible, you can also see hypervascularity. The mobility of the tympanic membrane was very restricted in otoscopy. All the posterior parts of the tympanic cavity are damaged, the remnants of the atrophic tympanic membrane lies on the promontory, the rear edge of the tympanic membrane is pulled so much that you cannot see the edges. The tympanic membrane creates so-called uncontrolled retraction pocket which inevitably leads to the cholesteatoma (fig. 1).

Symptoms, if present, may include aural fullness, plugged ear. Hearing loss may also be present. Often, chronic OME is asymptomatic, even in late stages with destruction of the tympanic membrane. If the atrophic tympanic membrane lies directly on the incudostapedial joint, hearing may by completely normal. Such otitis media with effusion in children is often associated with chronic, untreated adenoid and tonsills hypertrophy, upper respiratory tract infections and is very common in children affected with cleft palate.

Chronic otitis media with effusion and destruction of the tympanic membrane
Fig. 1 Chronic otitis media with effusion and destruction of the tympanic membrane
Chronic otitis media with effusion and destruction of the tympanic membrane - scheme
Fig. 1a Chronic otitis media with effusion and destruction of the tympanic membrane – scheme
  1. malleus handle
  2. pars tensa of the tympanic membrane – anterior quadrants
  3. promontory
  4. fluid level in tympanic cavity
  5. dotted line – deep retraction pocket in posterior quadrants
  • Because OME lasted several months, hearing was deteriorating and the evident destruction of the tympanic membrane was present, the decision of surgical treatment was made.
  • Range of surgical intervention: myringoplasty with tragus perichondrium, ventilation tube insertion and adenoidectomy.
  • Sometimes the condition like this requires antromastoidectomy and posterior tympanotomy if removal of the epithelium from facial recess is impossible from anterior tympanotomy approach.
  • The effusion and destruction of the tympanic membrane was a consequence of chronic eustachian tube obstruction due to adenoid hypertrophy and recurrent upper respiratory tract infections.
  • Non pharmacological methods e.g. nasal balloons were ineffective.
  • Nasal sprays with steroids were used ocassionally during upper respiratory tract infection with nasal obstruction.

Case II

This is a picture of the advanced, late stage, left ear, 14-year-old patient. There is almost complete destruction of the  tympanic membrane, which is bulging like balloon. Tympanic membrane is atrophic and very thin. Cone of light is invisible. The malleus and other structures of the middle ear are also invisible. The tympanic cavity is filled with a large amount of viscous, serous fluid. Characteristic air-fluid levels are invisible because fluid fills all the spaces of middle ear (tympanic cavity, mastoid) leaving no space for air. There is a high pressure in the tympanic cavity as a result of overproduction of fluid and poor eustachian tube function (fig. 2).

In this stage symptoms will include aural fullness, plugged ear, noticeable hearing loss and also ocasionally pain. There can be symptoms of the infection of the upper respiratory tract. Such otitis media with effusion may lead to the perforation of the tympanic membrane if the condition will advance to acute otitis media or even spontaneously. After the perforation is done, the hearing may improve. In children it is often associated with conditions leading to the significant eustachian tube problems.

Chronic otitis media with effusion and destruction of the tympanic membrane
Fig. 2 Chronic otitis media with effusion and destruction of the tympanic membrane
  • Because OME lasted several months, hearing was deteriorating and the evident destruction of the tympanic membrane was present, the decision of surgical treatment was made.
  • Range of surgical intervention: removal of the part of the atrophic tympanic membrane, myringoplasty with tragus perichondrium, ventilation tube insertion and adenoidectomy.
  • The effusion and destruction of the tympanic membrane was a consequence of chronic eustachian tube obstruction due to adenoid hypertrophy and recurrent upper respiratory tract infections.
  • Non pharmacological methods were ineffective.
  • One should not use autoinflation methods in cases like this.
  • Nasal sprays with steroids were used ocassionally during upper respiratory tract infection with nasal obstruction.

Case III

This is a picture of the advanced, late stage, left ear, 11-year-old patient with cleft palate. You may notice yellowish fluid in the tympanic cavity. The tympanic membrane is pulled in the pars tensa and flaccida as a result of chronic negative pressure in the tympanic cavity. The tympanic membrane forms so-called retraction pockets in anterior and posterior quadrants which are controlled – it means one can see all the parts including bottom of the pocket. In pars flaccida (locus minoris resistentiae of the tympanic membrane) there is uncontrolled retraction pocket. There is also small but evident destruction of the attic wall, the epithelium lies directly on the neck of the malleus, goes further to the head of the malleus in the attic. The lateral process of the malleus is protruding. The mobility of the tympanic membrane was very restricted in otoscopy. This is the initial stage of cholesteatoma (fig. 3 and 3a).

In this stage symptoms will include aural fullness, plugged ear, noticeable hearing loss. Pain is not common. There can be symptoms associated with conditions leading to the significant eustachian tube problems like cleft palate.

Chronic otitis media with effusion and destruction of the tympanic membrane
Fig. 3 Chronic otitis media with effusion and destruction of the tympanic membrane
Chronic otitis media with effusion and destruction of the tympanic membrane – scheme
Fig. 3a Chronic otitis media with effusion and destruction of the tympanic membrane – scheme
  1. anterior quadrants of tympanic membrane
  2. malleus handle
  3. lateral process of malleus
  4. uncontrolled retraction pocket in epitympanum
  • Because OME lasted several months, hearing was deteriorating and the evident destruction of the tympanic membrane was present, the decision of surgical treatment was made.
  • Range of surgical intervention: explorative tympanotomy, removal of the retraction pockets, myringoplasty with tragus perichondrium, ventilation tube insertion.
  • Sometimes the condition like this requires antromastoidectomy and posterior tympanotomy if removal of the epithelium from facial recess and epitympanum is impossible from anterior tympanotomy approach.
  • The effusion and destruction of the tympanic membrane was a consequence of chronic eustachian tube problems due to cleft palate.
  • Non pharmacological methods e.g. nasal balloons were ineffective.
  • Nasal sprays with steroids were used ocassionally during upper respiratory tract infection with nasal obstruction.