Ossicular Chain Defects in Adults with Chronic Otitis Media 

Bayat, Arash, et al. “Ossicular Chain Defects in Adults with Chronic Otitis Media.” The International Tinnitus Journal, The International Tinnitus Journal, 22 Mar. 2019, https://www.tinnitusjournal.com/abstract/ossicular-chain-defects-in-adults-with-chronic-otitis-media-11266.html. 

ossicular-chain-defects-in-adults-with-chronic-otitis-media

I did my journal article on my third H&P about the patient with otitis media. I thought this patient case was interesting because seeing otitis media in adult patients is rare. I found this article about chronic otitis media in adults leading to ossicular chain defects and wanted to learn more about it.  

Chronic otitis media is when the tympanic membrane is perforated and leads to the irritation and inflammation of the mucosal lining of the middle ear and inflammation to the air spaces of the temporal bones lasting for 2-6 weeks. It affects up to 330 million people worldwide, and more then half of them have significant hearing impairment. This degree of damage can be due to the amount of damage done on the middle ear structures. The ear ossicles in the middle ear are suspended by ligaments and tendons, if they are eroded or damaged it can cause a reduction in sound vibration transmission.  

This study was a retrospective clinical study done on 107 patients with chronic otitis media and its relation to the status of the middle ear ossicles. Patients with a history of prior ear surgery \, trauma, cholesteatoma and those with other comorbid conditions such as diabetes and renal failure were excluded. These patients were evaluated with temporal bone CT and audiometry. The hearing threshold was assessed based on the frequency range of 250-8000HZ.  

The purpose of this study was to assess how chronic otitis media can effect the structure of the ossicle chain and lead to conductive hearing loss, which in turn can lead to irreversible changed in the anatomy and functional integrity of the auditory canal. This can eventually lead to problems in many aspects such as language, emotion, cognitive and psychological issues. The results of this study found that changes and damage to the ossicular chain is prevalent in those with chronic otitis media. The found that out of the 3 ossicle bones, the incus was most susceptible to erosion, and the malleus was the most resistant.  

For this reason, otitis media should always be on the differential list for adult patients coming in for ear pain. They should also be treated with antibiotics in order to prevent the infection from eroding into the middle ear and causing damage to the ossicle structures. Often times, it is easy to assume that ear pressue in adults is due to sinus congestion or a viral URI, but they should be thoroughly examined and treated appropriately.