Middle Ear Cleft Opacification in Acute Otitis Externa: Sequela or Incidentaloma?

Area of Science:

• Otolaryngology
• Radiology
• Infectious Diseases

Background:

• Acute otitis externa (AOE) can lead to middle ear cleft opacification (MECO), but its mechanism and significance are not well-understood.
• Existing research primarily focuses on animal models, with limited clinical data on middle ear involvement in AOE.

Purpose of the Study:

• To investigate the occurrence, prevalence, and resolution dynamics of MECO following uncomplicated AOE in a clinical setting.
• To differentiate MECO as a sequela from signs of AOE deterioration or significant middle ear inflammation.

Main Methods:

• Retrospective analysis of brain imaging in 92 patients within 3 months post-AOE.
• Exclusion of patients with anatomical disruptions between the external and middle ear.
• Evaluation of MECO rate, dynamics, and affected middle ear cleft regions.

Main Results:

• MECO was observed in 38.0% of post-AOE ears versus 10.8% of contralateral ears (P=.002).
• MECO prevalence decreased significantly from 58.9% within 2 weeks to 8.0% at 3 months post-AOE.
• Opacification predominantly occurred in the upper middle ear cleft (epitympanum/mastoid) and transitioned from complete to partial over time.

Conclusions:

• Middle ear effusion is a common, self-resolving sequela of AOE.
• MECO following AOE does not typically indicate disease worsening or significant middle ear inflammation.
• Findings aid clinicians in managing AOE, avoiding unnecessary treatments, and interpreting imaging findings.