These are all inflammatory or infectious processes of the middle ear operating in a chronic fashion.
Mucosal chronic otitis media are benign principle, chronic otitis media cholesteatoma are dangerous and require surgical treatment.
Different etiological factors: inflammation and chronic obstruction of the upper airway maintaining inflammation of the Eustachian tube, local land fragility.
1- Simple chronic ear infections:
MUCOSAL EAR INFECTIONS:
A- Otitis media with effusion closed eardrum:
-> Child between 3 and 8 years (4%). Rare in adults (nasopharyngeal cancer?).
-> Diagnostics on the hearing loss in children behind in school.
-> Otoscopy: Matt eardrum slightly retracted, amber (yellow brown).
-> Deafness variable transmission 2O to 4O 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 mucosa open eardrum:
* Otitis mucosa open eardrum or tubal otorrhea has a generally bilateral otorrhea, mucous or mucopurulent.The tympanic perforation is earlier, or anterior inferior, or total.
* The role of the nasopharynx or the land is predominant and evolution is often very slow until the age of 8 years or puberty.
* Treatment is medical (removal of the adenoids, vaccine therapy, spa therapy). Never instill ototoxic drops.
* The tympanic perforation sequelae (acute necrotizing otitis after for example) can always secondary infection (swimming, push nasopharyngeal).
* Changes to tympanosclerosis possible, ossicular lysis possible, can epidermal pass.
* The treatment is preventative (abstention bathing) or surgery (tympanoplasty).
2- Cholesteatomatous chronicles:
The keratinizing 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 fund exist in young children.
Diagnosis: hearing loss and especially fetid purulent otorrhea, sometimes complications.
Otoscopy: Marginal perforation (Shrapnell, Posterior 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 treatment combining excision and tympanoplasty; often nécessaire.Surveillance second time control for the very long term as possible recurrence.