Pathogenesis and Treatment of Adhesive Otitis

Abstract

Adhesive otitis is an abacterial inflammation of the middle ear and the adjoining pneumatic spaces. It has a tendency to become chronic and is characterized by occlusion of the Eustachian tube and formation of adhesions in the tympanum. Three phases can be distinguished: the early stage (middle ear secretion frequently mucous and changes reversible), the adhesive stage (inflammation still in progress), and the terminal stage (inflammation has subsided). The incidence of adhesive otitis seems to be increasing. The following factors may be responsible: sulphonamide and antibiotic therapy, latent mastoiditis, and inadequate treatment of acute otitis media (neglect of myringotomy and air insufflation). During childhood in particular, some other factors, such as nasopharyngeal adenoids and sinusitis, may also give rise to chronic oto-salpingitis. This condition, unless properly treated, may lead to adhesive otitis. At the early stage, therapy consists of conventional evacuation of secretion from the middle ear, and care is taken to obtain proper ventilation and tubal function. The formation of adhesions may result in disappearance of the middle ear air space. Restoration of ventilation of the air space in the tympanum and of the sound conducting mechanism is possible in many cases by operation and medication. The air space of the tympanum can be maintained by means of a polyethylene tube introduced through the operation wound or the Eustachian tube. Air is insufflated into the middle ear daily through the polyethylene tube, through which medical preparations can also be injected.