[The effect of ear surgery to the immunologic defense system of the middle ear during chronic otitis media (author's transl)].

Alpha-1-antitrypsin and alpha-2-macroglobuline are very important proteinase inhibitors for the healing process in chronic otitis media, because they can inhibit numerous bacterial and leukocytic proteinases: Alpha-2-macroglobuline can block the malignant proteinases of pseudomonas aeruginosa, staphylococcus aureus and proteus vulgaris. In 58 cases in the middle ear secretion was examined and the level of alpha-1-antitrypsin and alpha-2-macroglobulin investigated pre- and postoperatively. By these investigations we could demonstrate that the postoperative level of these two inhibitors is higher than preoperatively. In a couple of cases with cholesteatoma the postoperative concentration of alpha-2-macroglobuline was nearly three times higher than prior to the tympanoplasty. We believe that one of the causes for this high inhibitor level is the liberation of alpha-2-macroglobuline by injuring blood vessels during a tympanoplasty. It is our opinion that the increase of the inhibitor level in the postoperative phase is one of the prerequisites for the healing process in chronic otitis media.