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Reaktionsformen der Mittelohrschleimhaut

The reactions of human middle ear mucous membrane

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Summary

Healthy middle ear mucous membrane of newborns differs from the respiratory mucous membrane of the respiratory tract, in that it lacks a mucociliary epithelial pattern and because it has an absence of cells responsible for immunological resistance.

Irritations over a short period of time and intensity cause a mucous membrane edema, which leaves behind, when the irritation disappeares, no permanent morphological changes in the structure of the mucous membrane. Severe irritations over a long period of time cause a characteristic change in the epithelium and submucosa: the single layered flat epithelium is replaced by respiratory epithelium; in the submucosa a proliferation of the connective tissue occurs simultaneously with the development of a local immunologically potent, cellular defense system. The actively secretive epithelial cells serve as the means whereby the antibodies are transported to the surface of the mucous membrane.

Whereas at the time of mucous membrane edema, serum components (transsudate) are the primary source of the resulting “serotympanum”, an increase in viscosity of the mucous allows one to recognize the active secretive work of the metaplastic epithelium.

The biochemical composition of the various effusions gives a direct indication of their origin: it is, however, no key to the cause! Only in the case of purulent secretions is it possible to recognize the cause by cellular or bacteriological identification.

The same is valid for the morphological changes of the middle ear mucous membrane since the membrane will generally react in a similar manner, even though the types of irritation differ.

When the stimulus which brought about the proliferation of the mucous membrane and the epithelial metaplasy disappeares, the active production of mucous stops. However, a regression to the original condition does not take place: the mucous membrane remains ready to react!

If any new irritations occur the membrane is now in the position to bring into action a fully developed defense system (mucociliary system, enzyme system, immunological system). It possesses than the same qualities as the respiratory mucous membrane of the upper respiratory tract; its responses are the same! This type of mucous membrane corresponds to the “hyperplastic type” described by Steurer and Wittmaack; Schwarz termed it the “constitutionally weak mucous membrane” because of its readyness to react.

If an irritation persists after metaplasy has developed, a “mucotympanum” will develop clinically; if the cause is bacterial, a chronic mucous membrane suppuration will be the result. If the eardrum is intact, a mucous membrane suppuration brought on by bacteria can change into a chronic mucotympanum throught (insufficient?) treatment with antibiotics or if there is an immunological defense weakness.

The changes and activities of the middle ear mucous membrane can however continue even when the irritation which caused them has ceased. An excessive immunological reaction, a functional disturbance of the mucociliary system as well as the ensuing disorder in Eustachian tube function play a determining role here. On the other hand, certain enzymes and a pathological concentration of fats and mucopolysaccharides — mediators and metabolic products of the inflammation itself — may cause further alterations of the membrane. These conditions may then follow: fibrosis or sclerosis of the mucous membrane, fibrosis or sclerosis of the tympanum, or cholesterol-granuloma.

Certain irritating conditions which act directly and only on the submucosal layer also lead to the same type of metaplastic change of the epithelium as is caused by an exogenous irritation. Among these conditions are above all the influence of the otosclerotic focus and tumorous or toxic disorders of the mucosal blood vessels (glomus jugulare tumor, idiopathic hematotympanum etc.).

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  1. Hals-Nasen-Ohren-Klinik der Universität Frankfurt am Main, Theodor-Stern-Kai 7, D-6000, Frankfurt 70

    W. Arnold

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Arnold, W. Reaktionsformen der Mittelohrschleimhaut. Arch Otorhinolaryngol 216, 369–473 (1977). https://doi.org/10.1007/BF00455140

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