Reiss Michael, Reiss Gilfe
Elblandkliniken Meissen, Krankenhaus Radebeul, HNO-Klinik, Heinrich Zille Str. 13, 01445 Radebeul.
Med Monatsschr Pharm. 2010 Jan;33(1):11-6; quiz 17-8.
The chronic otitis media is defined as a permanent perforation of the drum membrane, which does not close by itself, and an inflammatory reaction in the mucosa (mucositis) of the middle ear. Two main forms of the chronic otitis media are distinct: the suppurative otitis media and the cholesteatoma. The suppurative otitis media is often accompanied by secretion into the external ear canal (otorrhoe), but "dry ears" are also common. Other frequent, but not obligatory symptoms are hearing impairment, tinnitus, and aural pain or pressure. Although genetically determined microbial and immunological factors, as well as Eustachian tube characteristics, are supposed to be involved in the pathogenesis of chronic suppurative otitis media, many aspects of the pathogenesis still need to be clarified. Ear microscopy will show the perforation in the drum membrane. Further diagnostic tools are audiometry, vestibular testing, radiological examination (high-resolution computed tomography) and microbiological investigation. The curative treatment for chronic suppurative otitis media is surgery (tympanoplasty, i.e. closure of the perforation in the drum membrane and also--if necessary--the reconstruction of the ossicular chain), not conservative antimicrobial therapy.
慢性中耳炎定义为鼓膜永久性穿孔，穿孔不会自行愈合，且中耳黏膜存在炎症反应（黏膜炎）。慢性中耳炎主要有两种不同类型：化脓性中耳炎和胆脂瘤型中耳炎。化脓性中耳炎常伴有外耳道分泌物（耳漏），但“干耳”也较为常见。其他常见但并非必然出现的症状包括听力减退、耳鸣以及耳痛或耳内压迫感。尽管遗传决定的微生物和免疫因素以及咽鼓管特征被认为与慢性化脓性中耳炎的发病机制有关，但发病机制的许多方面仍有待阐明。耳镜检查可显示鼓膜穿孔。进一步的诊断工具包括听力测定、前庭测试、放射学检查（高分辨率计算机断层扫描）和微生物学检查。慢性化脓性中耳炎的治疗方法是手术（鼓室成形术，即封闭鼓膜穿孔，必要时还需重建听骨链），而非保守的抗菌治疗。
