Surgical advances in treating otitis media.

Surgical methods of treating otitis media and its sequelae are discussed, according to the classification of otitis media presented in an earlier report. Surgical management of otitis media with effusion and recurrent purulent otitis media includes myringotomy and use of ventilation tubes. Occasionally, otitis media with effusion will lead to structural and other pathologic changes in the middle ear, and conservative treatments such as use of medication or tubes will not suffice. Indications and methods for exploratory tympanotomy and reconstruction of the middle ear are discussed. In such instances, tympanoplasty can be used to the patient's benefit. Chronic otitis media with mastoiditis, defined by the presence of intractable pathologic tissue, generally requires surgical correction. Classic methods include simple mastoidectomy, modified radical (Bondy) mastoidectomy, and radical mastoidectomy. Current classifications of procedures would also include closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and intact-bridge tympanomastoidectomy (a combined approach). The diagnostic and surgical approach to silent or subclinical otitis media is discussed. Diagnosis and treatment of sequelae of otitis media, including sequelae in the middle ear and, less commonly, in the inner ear, are discussed.