[Classification of secretory otitis based on cytological analysis of middle ear transudate]

On the basis of the number of cell elements in the cytologic smear of the transudate from the middle ear, secretory otitis media was divided into four groups providing indication for therapeutic procedures. The first group is characterized by a mass of mucus and very scarce cell elements, suggesting a relatively short duration of illness and the healing by conservative therapy and adenoidectomy. The second group contained somewhat more cell elements in the cytologic smear, suggesting a longer duration of illness and requiring the use of a ventilation tubule in the therapeutic procedure. The third group showed a considerable cell infiltration and the appearance of individual collagenic fibres scattered in disorder in the smear. The transudate is dense, sticky, and dark. Its aspiration from the cavum is not easy. The finding suggests a long duration of illness, requiring a more active approach of the otosurgeon. The fourth group is characterized by a very scarce but dense aspirate from the middle ear. The cytologic smear shows an intense cell infiltration and a mass of collagenic fibres, which speaks for a very long duration of illness and for the necessity, in view of the formation of connective tissue in the middle ear, of an explorative tympanotomy coupled with adhesiolysis and the use of the ventilatory tubule.