Ear
Inflammatory / infectious / autoimmune / systemic disorders
Otitis media

Author: Nat Pernick, M.D. (see Authors page)

Revised: 8 February 2018, last major update October 2013

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Otitis media [title] review[ptyp] loattrfree full text[sb]

Cite this page: Pernick, N. Otitis media. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/earotitismedia.html. Accessed October 19th, 2018.
Definition / general
  • Acute or chronic infectious disease of middle ear
  • Usually childhood disease caused by Streptococcus pneumoniae or Haemophilus influenzae (Pediatr Infect Dis J 2004;23:1142); also coinfection by viruses (Clin Infect Dis 2006;43:1417)
  • Rarely caused by fungi or Pneumocystis in HIV+ patients
  • Hyperemic, opaque and bulging tympanic membrane with limited mobility; may have purulent otorrhea
  • Infection probably occurs post pharyngitis via eustachian tube
  • Severe cases are associated with destruction of ossicles
  • Tympanosclerosis: dystrophic calcification of tympanic membrane or middle ear associated with recurrent cases of otitis media, occurs in 3 - 33% of cases; may be reversible in children, usually irreversible in adults and associated with conductive hearing loss
Treatment
Gross description
  • Not a common specimen, but may have small fragments of soft / rubbery granulation tissue
Microscopic (histologic) description
  • Acute and chronic inflammatory cells, haphazard glandular metaplasia (Laryngoscope 1982;92:273) with cilia, fibrosis, hemorrhage, foci of calcification (tympanosclerosis), cholesterol granulomas and reactive bone formation
  • Cholesterol granulomas: foreign body granulomas in response to cholesterol crystals from rupture of red blood cells and breakdown of lipid bilayer in cell membrane, prominent cholesterol clefts; associated with interference to drainage or ventilation of middle ear space; not related to cholesteatomas
Differential diagnosis