Findings in a pair of temporal bones from a patient with secretory otitis media and chronic middle ear infection.

The histopathological changes in a pair of temporal bones from a 69-year-old woman who had secretory otitis media in the left ear and chronic middle ear infection in the right ear are described. Tympanostomy tubes had been placed in her left ear nine times. The perforation at the grommet showed no ingrowth of squamous epithelium; the fine structure of the tympanic membrane was normal. There were a few mucus strands present in the middle ear, which was lined with a one- to three-cell layer epithelium, where only a few secretory cells were found. In the right ear the thick tympanic membrane showed papillary projections of the squamous epithelium extending from the outer epidermal layer deep into the stroma and close to the collagenous layer of lamina propria. A large marginal perforation was present in the posterior quadrant, but there was no ingrowth of squamous epithelium from the canal into the middle ear. From the anterior margin, a concave veil-like sheet of squamous epithelium had grown onto the incus, chorda tympani and the stapes head. Numerous finger-like projections extended from the margin of this epithelium to the stapedial footplate and the epitympanum. The mucous membrane of the bony portion of the Eustachian tube in both ears was normal to the cartilage level, and the defective ventilation was in all likelihood caused by a dysfunction at the pharyngeal end of the Eustachian tube.