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Chronic Epitympanic Otitis Media Explained

Chronic epitympanic otitis media is a long-term inflammatory condition of the middle ear affecting the epitympanum. It often involves cholesteatoma formation and may require surgical treatment.

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Things worth knowing about "Chronic epitympanic otitis media"

Chronic epitympanic otitis media is a long-term inflammatory condition of the middle ear affecting the epitympanum. It often involves cholesteatoma formation and may require surgical treatment.

What is Chronic Epitympanic Otitis Media?

Chronic epitympanic otitis media is a persistent inflammatory disease of the middle ear that primarily affects the upper part of the tympanic cavity, known as the epitympanum (or attic). It is considered one of the more dangerous forms of chronic otitis media because it is frequently associated with the development of a cholesteatoma – a benign but locally destructive accumulation of squamous epithelium that can erode surrounding bone and ossicular structures.

Unlike the mucosal form (chronic mesotympanic otitis media), the epitympanic variant carries a higher risk of serious complications if left untreated.

Causes

The development of chronic epitympanic otitis media is typically multifactorial. Key contributing factors include:

Chronic Eustachian tube dysfunction leading to impaired middle ear ventilation
Recurrent acute otitis media in childhood
Retraction of the tympanic membrane, particularly in the pars flaccida region, leading to retraction pocket formation and ultimately cholesteatoma
Genetic predisposition influencing susceptibility to chronic ear infections
Previous ear trauma or surgery

Symptoms

Symptoms of chronic epitympanic otitis media can develop gradually and may go unnoticed for extended periods. Common signs and symptoms include:

Progressive hearing loss: usually conductive in nature, occasionally sensorineural
Ear discharge (otorrhoea): often foul-smelling, either intermittent or persistent
Sensation of pressure or pain in the ear
Tinnitus (ringing or buzzing in the ear)
In advanced stages: dizziness or vertigo due to inner ear involvement
In severe cases: symptoms of intracranial complication such as headache, fever, or neurological deficits

Diagnosis

Diagnosis is established through a combination of clinical examination and imaging studies:

Otoscopy: Visual inspection of the ear canal and eardrum; typical findings include perforation or retraction in the upper portion of the tympanic membrane (pars flaccida)
Ear microscopy: Detailed assessment using a surgical microscope
Audiometry: Evaluation of the degree and type of hearing loss
CT scan of the temporal bone: Imaging to assess bone erosion, cholesteatoma extent, and possible complications
MRI of the temporal bone: Particularly useful for differentiating cholesteatoma from other soft tissue changes and for postoperative follow-up

Treatment

Treatment of chronic epitympanic otitis media is primarily surgical, since a cholesteatoma will continue to grow and cause damage without removal.

Surgical Options

Tympanoplasty: Reconstructive surgery to restore middle ear function and repair the tympanic membrane
Mastoidectomy: Removal of diseased tissue from the mastoid process to eradicate cholesteatoma
Open technique (canal wall down / radical mastoidectomy): Used for extensive cholesteatoma; creates an open cavity for improved access and long-term control
Closed technique (canal wall up): Preserves the posterior ear canal wall; often requires a planned second-look surgery to check for residual cholesteatoma

Conservative Adjunct Therapy

Topical or systemic antibiotics may be used to manage active infection, particularly prior to surgery. However, conservative treatment alone is insufficient when cholesteatoma is present.

Complications

Without appropriate treatment, chronic epitympanic otitis media can lead to serious complications, including:

Destruction of the ossicular chain resulting in permanent hearing loss
Labyrinthitis causing vertigo and sensorineural hearing loss
Facial nerve palsy due to erosion of the facial nerve canal
Meningitis, brain abscess, or other intracranial complications

References

Probst R, Grevers G, Iro H: Basic Otorhinolaryngology – A Step-by-Step Learning Guide. Thieme, Stuttgart 2006.
Bluestone CD, Klein JO: Otitis Media in Infants and Children. 4th edition. BC Decker, Hamilton 2007.
Jackler RK, Driscoll CL: Tumors of the Ear and Temporal Bone. Lippincott Williams and Wilkins, Philadelphia 2000.

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