Secretory otitis media in chronic lymphatic leukaemia. A temporal bone report of a case treated for seven months with tympanostomy tubes.

Serially sectioned temporal bones were studied from a patient with chronic lymphatic leukaemia with submucosal infiltration of the nasopharynx, the resulting secretory otitis having been treated with tympanostomy tubes for 7 months. The initially serous sterile secretion turned mucoid, and a low grade infection supervened. For the last 3 months the tympanostomy tubes were open and the ears dry. In the sections, the mastoid air cells showed leukaemic infiltrations and contained AB- and PAS-positive secretion. The drum openings were without reaction and there was no epithelial ingrowth around the margins. The posterior tympanum in both ears contained organizing fibrous tissue extending from the inner surface of the drum to the promontory. In the tympanum the mucosa was flat or columnar and without glands. Distinct AB and PAS-positive mucus film and secretory cells appeared on the promontory epithelium and the inner surface of the drum. In the tubo-tympanic recess some AB- and PAS-positive subepithelial glands appeared and in the tympanic orifice of the tube the secretory cells were prominent and the lumen full of AB-positive mucus. The case reported represents an intermediate stage in the healing of secretory otitis media, most of the glands having disappeared but the intraepithelial secretory elements being still active.