Chronische mesotympanale Otitis media – Teil 1: Diagnostik & konservative Therapie

Dieses Update zum Thema der chronischen mesotympanalen Otitis media (CMOM) gibt einen Einblick zu neuen Erklärungsmodellen der Pathogenese des Krankheitsbildes, fasst die häufigsten Ursachen zusammen und bildet den aktuellen Stand in der Diagnostik und Therapie ab. Herauszuheben sind dabei neue Erkenntnisse zur Physiologie der Mittelohrschleimhaut, zur Pathogenese von Biofilmen und der aktuelle Stellenwert konservativer Therapieverfahren. Der Schwerpunkt mikrochirurgischer und minimalinvasiver Therapieverfahren soll nachfolgend in einem 2. Teil publiziert werden.

Abstract

Chronic mesotympanal otitis media (CMOM) is a well-developed clinical presentation that is established in diagnostics and therapy. On closer inspection, however, this principle cannot be confirmed in all its facets. Already the physiology and pathophysiology of the middle ear mucosa leave questions unanswered, starting with the distribution of the ciliated epithelium in the middle ear and mastoid to the function of gas exchange.

In addition, there are new diagnostic and therapeutic approaches. In the future, optical coherence tomography could help to determine the status of the middle ear mucosa. In addition, there are new findings on the effectiveness of local and systemic antibiotics as well as antiseptics in chronic otorrhea. Other new developments include minimally invasive surgical procedures using endoscopic techniques. All this gives reason to provide an update on the topic of chronic mesotympanal otitis media, which should contribute in preparation for the specialist examination or refreshing.

Basics of physiology and pathophysiology as well as new diagnostic approaches and medical treatment were covered in Part 1 of this paper. In Part 2, in addition to established methods, new developments in surgical therapy with minimally invasive surgical procedures are described in more detail.

Kernaussagen

• Bei der chronischen mesotympanalen Otitis media handelt es sich um eine auf die Schleimhaut begrenzte, in der Regel bakterielle Entzündung der Mittelohrräume.

• Das charakteristische klinische Zeichen ist ein zentraler Trommelfelldefekt.

• Zu unterscheiden sind ein aktives feuchtes Stadium mit Otorrhoe von einem inaktiven trockenen Stadium.

• Die chronische mesotympanale Otitis media führt nicht nur zu einer Schallleitungsschwerhörigkeit, sondern kann auch über das Eindringen von Bakterientoxinen das Innenohr schädigen.

• Für die Diagnosestellung sind Anamnese, Ohrmikroskopie und die Hörprüfung unabkömmlich. Eine Bildgebung ist nicht regelhaft notwendig, kann aber insbesondere präoperativ zur Beurteilung des Ossikelketten-Status verwendet werden.

• Im aktiven Exazerbationsstadium sind eine Ohrreinigung und lokale Antibiotikaapplikation, ggf. kombiniert mit Kortikosteroiden, indiziert.

• Im entzündungsfreien Stadium besteht die Indikation zur Tympanoplastik.

Schlüsselwörter

Chronische mesotympanale Otitis media - CMOM - Antibiotika - Antiseptika - Keimspektrum - Trommelfelldefekt - Tympanoplastik

Keywords

Chronic mesotympanal otitis media - CMOM - tympanic membrane defect - tympanoplasty

Publication History

Article published online:
03 August 2023

• Literatur

• 1 Morris P. Chronic suppurative otitis media. BMJ Clin Evid 2012; 2012: 0507 DOI: 10.1002/14651858.CD013056.pub2. (PMID: 31902139)
• 2 Kaftan H, Noack M, Friedrich N. et al. Prävalenz chronischer Trommelfellperforationen in der erwachsenen Bevölkerung. HNO 2008; 56: 145-150 DOI: 10.1007/s00106-007-1574-0.
• 3 Voss SE, Rosowski JJ, Merchant SN. et al. Middle-ear function with tympanic-membrane perforations. I. Measurements and mechanisms. J Acoust Soc Am 2001; 110: 1432-1444 DOI: 10.1121/1.1394195.
• 4 Peng KA, Linthicum FH. Atrophy of the Stria Vascularis. Otol Neurotol 2016; 37: e9-11 DOI: 10.1097/MAO.0000000000000935. (PMID: 26719961)
• 5 Paparella MM, Oda M, Hiraide F. et al. Pathology of Sensorineural Hearing Loss in Otitis Media. Ann Otol Rhinol Laryngol 1972; 81: 632-647 DOI: 10.1177/000348947208100503. (PMID: 4631219)
• 6 Dobrianskyj FM, Dias Gonçalves ÍR, Tamaoki Y. et al. Correlation Between Sensorineural Hearing Loss and Chronic Otorrhea. Ear Nose Throat J 2019; 98: 482-485 DOI: 10.1177/0145561319840573.
• 7 Rajput MS-A, Rajput MSA, Arain AA. et al. Mucosal Type of Chronic Suppurative Otitis Media and the Long-Term Impact on Hearing Loss.. Cureus 2020; 12: e10176 DOI: 10.7759/cureus.10176.
• 8 Aarhus L, Tambs K, Kvestad E. et al. Childhood Otitis Media: A Cohort Study With 30-Year Follow-Up of Hearing (The HUNT Study). Ear Hear 2015; 36: 302-308 DOI: 10.1097/AUD.0000000000000118.
• 9 Padurariu S, Röösli C, Røge R. et al. On the functional compartmentalization of the normal middle ear. Morpho-histological modelling parameters of its mucosa. Hear Res 2019; 378: 176-184 DOI: 10.1016/j.heares.2019.01.023. (PMID: 30826128)
• 10 Hüttenbrink KB. Surgical treatment of chronic otitis media. I: Indications, preoperative care and surgical principles. HNO 1994; 42: 582-593 (PMID: 7989230)
• 11 Minami SB, Mutai H, Suzuki T. et al. Microbiomes of the normal middle ear and ears with chronic otitis media. Laryngoscope 2017; 127: E371-E377 DOI: 10.1002/lary.26579.
• 12 Mofatteh MR, Shahabian Moghaddam F, Yousefi M. et al. A study of bacterial pathogens and antibiotic susceptibility patterns in chronic suppurative otitis media. J Laryngol Otol 2018; 132: 41-45 DOI: 10.1017/S0022215117002249.
• 13 Mittal R, Debs LH, Patel AP. et al. Otopathogenic Staphylococcus aureus Invades Human Middle Ear Epithelial Cells Primarily through Cholesterol Dependent Pathway. Sci Rep 2019; 9: 10777 DOI: 10.1038/s41598-019-47079-7.
• 14 Parrish JM, Soni M, Mittal R. Subversion of host immune responses by otopathogens during otitis media. J Leukoc Biol 2019; 106: 943-956 DOI: 10.1002/JLB.4RU0119-003R. (PMID: 31075181)
• 15 Jakob TF, Zaoui K, Kromeier J. et al. Virtual Quality Control in Middle Ear Surgery: Is Image-guided Tympanoscopy a Valuable Tool for Depicting Borderline Situations?. Otol Neurotol 2020; 41: e893-e900 DOI: 10.1097/MAO.0000000000002483. (PMID: 32658106)
• 16 Güldner C, Diogo I, Bernd E. et al. Visualization of anatomy in normal and pathologic middle ears by cone beam CT. Eur Arch Otorhinolaryngol 2017; 274: 737-742 DOI: 10.1007/s00405-016-4345-2. (PMID: 27752754)
• 17 Head K, Chong LY, Bhutta MF. et al. Antibiotics versus topical antiseptics for chronic suppurative otitis media. Cochrane Database Syst Rev 2020; 1: CD013056 DOI: 10.1002/14651858.CD013056.pub2. (PMID: 31902139)
• 18 Renukananda GS, Santosh UP, George NM. Topical vs Combination Ciprofloxacin in the Management of Discharging Chronic Suppurative Otitis Media. J Clin Diagn Res 2014; 8: KC01-KC04 DOI: 10.7860/JCDR/2014/8038.4421.
• 19 https://register.awmf.org/assets/guidelines/017-066l_S2k_Antibiotikatherapie_der_Infektionen_an_Kopf_und_Hals_2019-11_1.pdf
• 20 Peek NFAW, Nell MJ, Brand R. et al. Ototopical drops containing a novel antibacterial synthetic peptide: Safety and efficacy in adults with chronic suppurative otitis media. PLoS One 2020; 15: e0231573 DOI: 10.1371/journal.pone.0231573.
• 21 Lefebvre M-A, Quach C, Daniel SJ. Chronic suppurative otitis media due to nontuberculous mycobacteria: A case of successful treatment with topical boric acid. International Journal of Pediatric Otorhinolaryngology 2015; 79: 1158-1160 DOI: 10.1016/j.ijporl.2015.04.043. (PMID: 26026892)