Tympanic membrane middle ear pathologic correlates in chronic otitis media

Objective: To correlate pathologic findings of the tympanic membrane with p athologic changes in the middle ear cleft in chronic otitis media. Study De sign: Retrospective. Material and Methods: One hundred-fifty temporal bones from 97 subjects with chronic otitis media (defined as middle ear patholog ic changes including granulation tissue, fluid, cholesteatoma, cholesterol granuloma, tympanosclerosis, and ossicular changes) were selected to correl ate the presence of these middle ear pathologies with histopathologic chang es of the tympanic membrane. The tympanic membrane pathologies included per foration, myringosclerosis, retraction, hemorrhage, fluid-filled cystic spa ces, or dilated vessels. Temporal bones were also assessed for atelectasis, Fifty-six normal temporal bones were taken as controls for measurements, R esults: Significant correlations between tympanic membrane and middle ear p athology included myringosclerosis and granulation tissue, myringosclerosis and ossicular pathology, retraction and cholesterol granuloma, retraction and cholesteatoma, retraction and ossicular pathology, perforation and ossi cular pathology, and hemorrhage and granulation tissue. Additive effects of some pathologies were also observed. Almost half the bones with middle ear pathology had no associated tympanic membrane pathology, whereas multiple pathologic changes in the tympanic membrane generally showed underlying mul tiple pathologic changes in the middle ear. Conclusion:When tympanic membra ne pathology is detected otoscopically, its presence, alone or in combinati on, can be a strong indicator of underlying middle ear pathology. However, a normal-appearing tympanic membrane does not exclude the possibility of mi ddle ear pathology. These findings suggest the need for other diagnostic to ols such as multifrequency tympanometry and otoacoustic emissions to comple ment otoscopy for diagnosis of middle ear pathology, especially in a tympan ic membrane that appears "normal.".