Secretory otitis. Histopathology and goblet-cell density in the Eustachian tube and middle ear in children.

The histological changes in the middle ear of four children with incipient or mild chronic secretory otitis are described. They consist in vascular dilatation and proliferation, round-cell infiltration, epithelial metaplasia into pseudostratified, columnar, ciliated epithelium posteriorly in the middle ear, formation of abnormal mucous tubular glands, and an increase in goblet-cell density in the osseous tube and middle ear. The causes of these changes were presumably long-lasting tubal occlusion due to a permanent nasogastric tube and protracted catarrhal diseases. The density of goblet cells was determined in various parts of the Eustachian tube and middle ear. The findings were analysed statistically and compared with the density in prematures and newborns, normal children, and normal adults. In the tympanic orifice and in the osseous Eustachian tube the goblet-cell density was greatly increased, whereas the increase in the middle ear varied individually, but was in conformity with the other findings. These cases illustrate that the histopathological changes in the middle-ear mucosa in secretory otitis must be regarded not only from a qualitative, but certainly also from a quantitative point of view.