Chronic Ear Infections

Anatomy

The tympanic membrane is located in the end of the outer ear canal and separates the middle ear from the outer ear (Figure). Sound waves, coming along the outer ear canal vibrate the tympanic membrane and this vibration vibrates the three small bones in the middle ear that are in touch with the tympanum and transmits the sound waves to the middle ear. 

Eustachian tube, connecting the middle ear to the nasal passage behind the nasal cavity and balancing the pressure in the middle ear with the atmospheric pressure and air cells connected to the middle ear and that are found inside the mastoid bone located behind the ear consists the other anatomical structures of the middle ear.

Figure: Ear Anatomy 

What are the types of chronic otitis media?

Many different types of chronic otitis media are present. In practice, two types are mostly encountered.

Perforations of the tympanic membrane, forms as a result of acute middle ear infections, traumas or ear surgeries that cannot heal up spontaneously or with simple interventions are the most frequently seen chronic middle ear diseases.  By water leakage to the middle ear from this hole or due to infections coming to the middle ear via sinuses or nasal passage may sometimes lead to the formation of inflammatory discharge in the ear and hearing may deteriorate in time due to recurrent infections. These groups of problems are chronic middle ear problems that are frequently encountered and these are relatively easy to treat with more successful functional outcomes.

The second important chronic middle ear disease is observed due to the malfunction of eustachian tube from childhood. This disease starts with the collapsing of tympanic membrane by being pulled into the middle ear as a result of the negative pressure formed due to ventilation disorder in the middle ear. Following the collapse and sac formation in the tympanic membrane, the skin of the outer ear canal proceeds into the middle ear and then into the mastoid bone in time forms an inflammatory mass called cholesteatoma. Cholesteatoma mass, containing the cells coming off the ear canal skin proceeding into the inner parts of the ear and the bacteria propagating in this environment, dissolves the surrounding bones with the help of pressure and inflammation and spreads to the neighboring organs and may lead to severe complications. 

In general, deteriorating hearing loss and sometimes increasing and foul smelling ear discharge history is present. Patients may apply to a hospital with severe ear originated complications of fulminant hearing loss, vertigo, facial palsy or with severe complications like meningitis, brain abscess due to the spreading of the inflammation inside the head.

The goal in the surgical treatment of chronic otitis media with cholesteatoma is primarily preventing the formation of inflammation.  The results obtained from the hearing function in these patients are not favorable compare to the patients of the first group.