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Chronic Mesotympanic Otitis Media – Causes and Treatment

Chronic mesotympanic otitis media is a long-term middle ear infection characterized by a central eardrum perforation without cholesteatoma, causing recurrent ear discharge and hearing loss.

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Things worth knowing about "Chronic mesotympanic otitis media"

Chronic mesotympanic otitis media is a long-term middle ear infection characterized by a central eardrum perforation without cholesteatoma, causing recurrent ear discharge and hearing loss.

What is Chronic Mesotympanic Otitis Media?

Chronic mesotympanic otitis media is a persistent inflammation of the middle ear defined by a permanent, centrally located perforation of the eardrum (tympanic membrane). Unlike the epitympanic or marginal forms, this condition is classified as a benign type of chronic otitis media because it does not involve a cholesteatoma (an abnormal growth of skin cells within the middle ear). The disease can persist for months to years and is one of the most common causes of chronic conductive hearing loss worldwide.

Causes

The condition most commonly develops as a consequence of recurrent acute otitis media, particularly during childhood. Key causes and risk factors include:

Incompletely healed acute middle ear infections
Chronic Eustachian tube dysfunction (impaired ventilation of the middle ear)
Traumatic perforation of the eardrum
Immune deficiency or increased susceptibility to infections
Unfavorable socioeconomic conditions and limited access to healthcare

Symptoms

Symptoms may occur in episodes or be persistent. The most common signs include:

Ear discharge (otorrhea): Recurrent, usually odorless drainage from the ear, often triggered by upper respiratory infections or water exposure
Hearing loss: Conductive hearing impairment due to the eardrum defect and possible ossicular damage
Sensation of pressure or fullness in the ear
Occasional tinnitus (ringing in the ear)
Ear pain is rarely present, in contrast to the acute form

Diagnosis

Diagnosis is established by a thorough ENT (ear, nose, and throat) examination. The following methods are commonly used:

Otoscopy: Direct visualization of the eardrum using an otoscope; the central perforation is typically clearly visible
Otic microscopy: More detailed assessment of the tympanic membrane and middle ear structures under a microscope
Audiometry: Measurement of the degree and type of hearing loss
Tympanometry: Assessment of middle ear function and eardrum mobility
Microbiological swab: Identification of causative pathogens during active discharge to guide antibiotic therapy
Imaging (CT of the temporal bone): Indicated when complications are suspected or for preoperative surgical planning

Treatment

Conservative Treatment

During active infections, conservative management is the initial approach:

Topical ear drops with antibiotic and/or anti-inflammatory properties (e.g., ciprofloxacin-containing drops)
Systemic antibiotics in cases of extensive infection or complications
Regular ENT-performed ear cleaning (suction of secretions)
Strict water precautions to prevent water from entering the ear (e.g., during swimming or showering)

Surgical Treatment

The long-term goal is surgical closure of the eardrum defect to restore hearing and prevent recurrent infections:

Myringoplasty (Type I tympanoplasty): Surgical repair of the eardrum perforation using autologous tissue (e.g., temporalis fascia); this is the method of choice when the ossicular chain is intact
Tympanoplasty (Types II-IV): More extensive reconstruction when the ossicles are also involved
The ear should generally be free from infection and dry for several months before surgery

Possible Complications

If left untreated, the following complications may arise:

Progressive and permanent hearing loss
Damage to the ossicular chain (ossicular dysfunction)
Spread of infection to the mastoid bone (mastoiditis)
In rare cases: meningitis, brain abscess, or facial nerve palsy

References

World Health Organization (WHO): Chronic suppurative otitis media. Burden of Illness and Management Options. WHO Press, Geneva, 2004.
Luers J.C., Huttenbrink K.-B.: Surgical anatomy and pathology of the middle ear. Journal of Anatomy, 2016; 228(2): 338-353. PubMed PMID: 26455576.
Semaan M.T., Megerian C.A.: The pathophysiology of cholesteatoma. Otolaryngologic Clinics of North America, 2006; 39(6): 1143-1159. PubMed PMID: 17097440.

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