Ear
Inflammatory / infectious / autoimmune / systemic disorders
Otitis media
Author: Nat Pernick, M.D.
Last author update: 1 October 2013
Last staff update: 15 December 2020
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Otitis media [title] review[ptyp] loattrfree full text[sb]
Table of Contents
Definition / general | Treatment | Gross description | Microscopic (histologic) description | Differential diagnosis | Additional referencesCite this page: Pernick N. Otitis media. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/earotitismedia.html. Accessed June 3rd, 2023.
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
- Antibiotics (Pediatr Infect Dis J 2006;25:1102) or observation (Lancet 2006;368:1429)
- Complications of mastoiditis, labyrinthitis, meningitis or abscess are now rare
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
- Middle ear adenoma: regular, not haphazard glands, no cilia
