Classification

Inflammatory diseases of the middle ear and mastoid are categorized according to the underlying disease process and location:

1. Acute suppurative otitis media (AOM) is characterized by obstruction of the eustachian tube, allowing the retention and suppuration of retained secretions. AOM is the medical term associated with, most commonly, the acute ear infection of childhood. Generally the course of this infection is self-limited, with or without medical treatment, and the retained infected secretions are discharged through either the eustachian tube or a ruptured tympanic membrane.

Acute coalescent mastoiditis can result from failure of these processes to evacuate the abscess. Coalescence of disease within the mastoid leads to pus under pressure and ultimately dissolution of surrounding bone. This condition may require urgent surgical evacuation because the infection is capable of spreading to local and regional structures.

3. Otitis media with effusion (OME) is an inflammatory condition of the middle ear in which serous or mucoid fluid accumulates. Both AOM and OME are precursor conditions to tympanic membrane retractions and perforations. Ongoing eustachian tube dysfunction predisposes to persistent retained secretions in the ear and recurrent acute attacks of otitis media. A small percentage of these patients develop a chronic tympanic membrane perforation which, in most cases, allows eventual aeration of the middle ear and mastoid air-cell spaces and resolution of the underlying disease process.

4. Chronic suppurative otitis media (CSOM) is defined as an ear with a tympanic membrane perforation. Benign CSOM is characterized by a dry tympanic membrane perforation, unassociated with active infection. Active CSOM is the result of intermittent bacterial infection often in the presence of ingrown skin in the middle ear and mastoid cavities. This skin ingrowth is known as cholesteatoma formation. Primary acquired cholesteatoma occurs through a tympanic membrane retraction into the attic of the middle-ear space, with a subsequent potential for extension into the middle ear and mastoid air-cell systems. Secondary acquired cholesteatoma is defined as skin growth through a tympanic membrane perforation into the ear.

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