Chronic otitis media is defined as “simple” in the presence of a long-standing tympanic perforation, without complications such as cholesteatoma. It is a chronic infection of the middle ear. The presence or absence of otitis symptoms is related to the phase (active or not) of the disease, any involvement of the mastoid bone, and the presence or absence of a tympanic perforation. The accompanying symptoms of the active phase of otitis can be:

• otorrhea (discharge of material from the ear, sometimes foul-smelling);
• hearing loss (decreased hearing);
• tinnitus (ringing, buzzing, pulsations);
• vertigo;
• pain;
• rarely facial nerve paralysis.

The types of otitis media are:

• acute otitis media;
• otitis media with effusion (also known as serous-mucous otitis);
• chronic suppurative otitis media;
• adhesive otitis media.

In children, acute otitis media and otitis media with effusion are more common, whereas chronic suppurative otitis media is more frequent in adults.

CHOLESTEATOMA

A particular form of chronic otitis is cholesteatoma, which consists of a cyst of desquamated skin that accumulates in the middle ear and mastoid, with expansive and destructive tendencies on the surrounding structures. If not removed, this cyst continues to grow, destroying the surrounding structures (in order: the ossicles, the inner ear, the facial nerve, up to the involvement of the meninges and the brain).

There are two types of cholesteatoma:

• congenital;
• acquired.

Acquired cholesteatoma, which represents the most common form, can be caused by a pathological alteration of the tympanic membrane with a tendency to accumulate keratin within the middle ear. More rarely, the pathology can be caused by a developmental anomaly of the ear structures; in this case, the cholesteatoma develops from birth in the form of a retro-tympanic keratin cyst. The treatment of cholesteatoma and some forms of chronic otitis media is surgical.