ULTRASTRUCTURE OF THE MIDDLE-EAR MUCOSA IN PATIENTS WITH CHRONIC OTITIS-MEDIA WITH CHOLESTEATOMA

Mucosa of the middle ear was obtained from the promontory wall in each of 20 patients during cholesteatoma surgery. Specimens were processed for both scanning and transmission electron microscopy. Non-ciliated mucosal cells were commonly found, with most being secretory cells wit h secretory droplets and microvilli. The patterns of distribution of m icrovilli on the surface of these cells were variable. The interciliar y spaces were stagnated with secretion. Bacilli were present in five c ases. Falloff of mucosal cells was common and intercellular spaces wer e widened. Compound cilia were observed sporadically. Polymorphic nucl ear inflammatory cells, macrophages and fibroblasts appeared in the su bmucosal area. These findings indicate that although remaining adjacen t mucosa after removal of cholesteatoma looks free of disease under th e operating microscope, it is actually in a diseased condition with im paired mucociliary function. The cells and bacteria seen microscopical ly may account for postoperative inflammation, thus warranting continu ed postoperative antimicrobial medication.