Ossicular Damage in Chronic Middle Ear Inflammation

Abstract

Out of 1280 ears operated on for four various types of chronic otitis media, 798 ears which had been operated on for the first time were analysed with computer assistance for frequency and type of ossicular lesion. These ears fitted into four different pathological entities: I) Of 97 ears with epidermoid (attic) cholesteatoma, 82.5% showed some ossicular lesion; total destruction of one ossicle was found in 64.3%. 2) Of 30 ears with retraction pocket cholesteatoma, 83.3% presented some ossicular lesions; total destruction of at least one ossicle was found in 33.3%. 3) 42 atelectatic ears (mostly grade IV) presented 66.7% of ossicular lesions, with 21.4% of ears having at least one ossicle completely destroyed. 4) 629 cases of simple chronic otitis media presented 25.4% of some ossicular lesion, with 2.6% ears presenting at least one ossicle completely destroyed. Ten stapes, five incudi and two mallei in the simple chronic otitis media cases were completely destroyed. In the simple chronic otitis media cases, ossicular damage was significantly more frequent in ears with posterior-superior or large perforations than in central, small or anterior perforations (Fig. 7, Table 11). In this group. ossicular lesions were also found to be five times more frequent in wet, inflamed ears than in those with dry perforations (P<0.001).

This study confirms the theory that bony damage (i.e., ossicular damage) in the various chronic otitis media syndromes has a chronic inflammatory process as a common denominator. While the intimate mechanism of the bony destruction process is very complicated, there is, so far, no evidence that stratified squamous epithelium per se is directly involved is ossicular destruction. or that it secretes any noxious substance or enzyme which destroys or contributes to bony destruction. Our aim should be to eliminate the inflammatory process. Self-cleansing and non-infected stratified squamous epithelium may be regarded as innocent.