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[Otitis nigra: etiologic pathogenetic and clinical aspects (author's transl)]
Laryngologie, Rhinologie, Otologie
|March 1, 1979
Summary
Otitis nigra, a distinct form of middle ear inflammation, involves vascular damage and cholesterol granuloma formation. Viral infections are implicated as a potential cause, necessitating surgical intervention for complete eradication.
Area of Science:
- Otolaryngology
- Pathology
- Virology
Background:
- Otitis nigra, also known as idiopathic sero-hemmorrhagic otitis media, is presented as an independent clinical entity.
- Five cases requiring mastoid surgery highlight the severity and clinical presentation of this condition.
Observation:
- Microscopic examination revealed pathological changes in small subepithelial vessels, characterized by increased permeability and extravasation of blood components.
- Erythrocyte disintegration resulted in hemosiderin and ferritin formation, while cell membrane phospholipids led to cholesterol crystal deposition.
- Secretory activity was observed in mucosal cells and subepithelial structures, with the presence of neutral and acidic mucopolysaccharides.
Findings:
- Cholesterol deposits induced foreign body reactions, leading to the formation of cholesterol granulomas.
- Virus-like inclusion bodies and particles were identified in macrophages, fibrocytes, and antral smears.
- Myxoviruses, specifically from the parotitis-epidemica group, were detected serologically, supporting a viral etiology.
- The presence of immunoglobulin-producing plasma cells indicated a stimulated local immune response, consistent with viral infection.
Implications:
- The findings suggest that subclinical viral infections may trigger the vascular lesions central to otitis nigra pathogenesis.
- Effective therapy involves mastoidectomy combined with posterior tympanotomy to ensure complete removal of diseased mastoid mucosa.
- Understanding the viral link and pathological mechanisms is crucial for managing this intractable otitis media variant.