These are all inflammatory or infectious processes of the middle ear developing on a chronic fashion.
Mucosal chronic otitis media are benign principle, chronic otitis media cholesteatoma are dangerous and require surgical treatment.
Different etiological factors: chronic inflammation or obstruction of the upper airway inflammation maintaining theEustachian tube, local land fragility.
1- Simple chronic ear infections:
MUCOSAL ear infections:
Otitis media with effusion
A- closed eardrum:
→ Children between 3 and 8 years (4%). Rare in adults (nasopharyngeal carcinoma).
→ Diagnostics on the hearing loss in children behind in school.
→ Otoscopy: matt eardrum slightly retracted, amber (yellow-brown).
→ Deafness variable transmission to 4O 2O dB. Tympanogram flat impedance measurement.
→ variable Evolution:
* Spontaneous recovery in the summer,
* Persistent deafness and educational backwardness,
* Retraction pocket and ossicular lysis and cholesteatoma.
* Recent stage serous: antibiotics and corticosteroids, paracentesis and suction removal of vegetation;
* Mucous stage tiller deafness .Treatment additional ventilation tubes: Processing of the ground, spa treatments do not prevent frequent recurrences (3O% of cases).
B- Otitis open tympanic mucosa:
* Otitis mucosa open tubal otorrhea or eardrum has a generally bilateral otorrhea, mucous or mucopurulent.Tympanic perforation is earlier, or anterior inferior, or total.
* The role of the nasopharynx or land predominates and evolution is often very slow until the age of 8 years or puberty.
* The treatment is medical (removal of the adenoids, vaccine therapy, spa therapy). Never instill ototoxic drops.
* The tympanic perforation sequelae (after acute necrotizing otitis example) can always secondary infection (swimming, push nasopharyngeal).
* Evolution towards possible Tympanosclerosis, ossicular lysis possible, be epidermal passage.
* The treatment is preventative (abstention swimming) or surgical (tympanoplasty).
2- chronic otitis cholesteatomatous:
The keratinized squamous epithelium of the eardrum and the conduit enters the middle ear to the favor of a retraction of the membrane Shrapnell or pars tense, or by direct epidermal migration. Some congenital cholesteatoma of the anterior superior cash exist in young children.
Diagnosis: hearing loss and especially fetid purulent otorrhea sometimes complications.
Otoscopy: marginal perforation (Shrapnell, posterior superior region of the body which is actually the collar of a pocket full of cholesteatoma).
Search a sign of the fistula to the pneumatic test.
TDM to specify the extension.
Surgical excision and combining tympanoplasty; often nécessaire.Surveillance second time control for the very long term as possible recurrence.