Chronische mesotympanale Otitis media – Teil 2: operative Therapie

Die chronische mesotympanale Otitis media (CMOM) ist ein inzwischen gut erschlossenes Krankheitsbild. Grundlagen der Physiologie und Pathophysiologie, neue diagnostische Ansätze und die konservative Therapie wurden in Teil 1 dieses Beitrags behandelt. In Teil 2 werden nun neben etablierten Methoden neue Entwicklungen in der chirurgischen Therapie mit minimalinvasiven Operationsverfahren eingehender beschrieben.

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

• Im aktiven Exazerbationsstadium sind die Ohrreinigung und lokale Antibiotikaapplikation, ggf. kombiniert mit Kortikosteroiden, indiziert. Im entzündungsfreien Stadium besteht die Indikation zur Tympanoplastik.

• Eine dringliche Indikation besteht, wenn eine Komplikation vorliegt oder befürchtet wird.

• Eine Operation in der akuten Phase der CMOM ist möglich, erschwert aber in der Regel das operative Vorgehen und den OP-Erfolg. Präoperativ sollte durch Ohrreinigung und lokale Ohrentropfen versucht werden, das Ohr „trocken zu bekommen“.

• Der Verschluss einer Trommelfellperforation dient dem Wasser- und Bakterienschutz des Mittelohrs, zum anderen geht es um die Rekonstruktion der Schallmembran. Weiterhin kann langfristig ein Austrocknen der Bänder und Gelenke vermieden werden.

• Die chronische mesotympanale Otitis media kann über Jahre hinweg auch zu einer Destruktion der Ossikelkette führen. In diesen Fällen muss neben dem Verschluss der Trommelfellperforation auch die Kettenrekonstruktion erfolgen.

• Der Hammergriff ist eine für die Schallübertragung des rekonstruierten Mittelohrs entscheidende Struktur.

• Alternative Techniken zur Rekonstruktion werden vor allem in der endoskopischen Chirurgie individualisiert eingesetzt. Die Evidenzlage zu Vorteilen gegenüber der klassischen Underlay-Technik ist bisher gering.

Schlüsselwörter

Chronische mesotympanale Otitis media - CMOM - Trommelfelldefekt - Tympanoplastik

Keywords

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

Publication History

Article published online:
04 October 2023

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