CLINICAL AND HISTOPATHOLOGICAL STUDIES OF TYMPANOPLSTY

Abstract

This investigation is concerned with an analy-sis of the histopathologic changes in the middle ear mucosa of 93 patients with chronic non-cholesteat-omatic otitis media and 33 patients with chronic cholesteatomatic otitis media.
The middle ear mucosa at the area of the pro-montrium, tympanic opening of the tube, fossa ovalis, epitympanum, and antrum, are investigated to compare with clinical findings observed in tym-panoplasty.
In most instances both clinical and histological findings of the mucosa are well agreeing but discr-epancy is also not infrequent.
In non-cholesteatomatic otitis, disagreement between clinical and histological findings mostly occurs in the cases that show slight thickening of the mucosa clinically but in histology keratinized squamous epithelium. In cholesteatomatic otitis, errors are most frequently made in those mucosa which present clinically no evidence of cholesteat-oma but in histology evidence of keratinized squa-mous epithelium. In analizing the causes of such clinical misinterpretation, it is found that errors occurred when the surface of the mucosa was cov-ered with discharge or when the mucosa presented reddening. When such changes are present, it se-ems to be not easy that clinical findings of mucosa in tympanoplasty are exactly evaluated.
Being based upon the clinical and histological changes of the mucosa, in the further steps, diagn-ostic criteria are tentatively established that diffe-rentiate which mucosa is to be removed or preser-ved in tympanoplasty.
From histological view point, pathologic findi-ngs of the mucosa to be absolutely removed opera-tively are keratinized squamous epithelium, necro-sis, cyst, glandular structure, cholesterol granuloma and relatively are calcification and moderate to severe fibrosis.
On this histological criteria, clinical signs indi-cating operative removal of the mucosa are edem-atous swelling, granulation, calcification, epitheliali-zation and presence of cholesteatoma.
In the region of epitympanum and antrum mucosa presnting thickening clinically should also be removed.
These observations demand reappraisal of clini-cal findings on which presently preservation of the mucosa is suggested, and also they, have evidenced one factor of reccurrent otorrhea postoperatvely and given some suggestion for the prophylax of postope-rative reccurrent inflammation.