XXX A Survey of Middle Ears: 101 Autopsies of Infants

Abstract

The earliest study of magnitude of the middle ears of infants was done by Aschoff in 1897 1 which included gross examination of the opened tympanic cavities of autopsied infants, followed by histologi cal preparations. Among other aspects, Aschoff was concerned with amnionic debris within the middle ear cavities. The next major arbeits of a similar nature were performed by Wittmaack in 1918 and in 1926 2 in which he proposed that irregularities of the mastoid air spaces represented abnormal development, and that pathological types of mucosa influenced the susceptibility to otitis media.In 1940 Diamant 3 demonstrated normal variation in size and distribution of mastoid air spaces in the general population by use of planimetric measurements on roentgen pictures taken partly of normal mastoids and partly of instances of chronic otitis media.In 1948 Diamant and Lilja 4 reported a series of patients in which pre-operative roentgenography was correlated with histological studies of mastoidectomy bone chips.Material obtained from 375 mastoidectomies were studied by Friedmann in 1956 5 from which he concluded that no evidence existed which would indicate that the basic pathology of otitis media had changed in the post-penicillin era; that the mucosa of the ear is very susceptible to infection, and that the hyperplastic mucosa and osteo plastic processes which were observed were the result, rather than the predisposing factor, of otitis media. Studies of temporal bone infec tions in the antibiotic era have been reported by various investi gators. 00In 1953, Werne and Garrow reported a large series of necropsies of infants dying in various circumstances. Their series included in fants "found dead," 11 infants observed to die suddenly, 12 and those From the Division of Pathology and Microbiology, University of Tennessee and the City of Memphis Hospitals.

Abnormalities of the Neonatal Ear: Otoscopic Observations, Histologic Observations, and a Model for Contamination of the Middle Ear by Cellular Contents of Amniotic Fluid

“…10. Right ear at 35 weeks' gestation and 1-day postpartum; level of eustachian tube (ET). The malleus is positioned medially, causing periosteal and bone interruption of the promontory (arrow), which obviously has occurred antenatally.…”

High-Risk Newborns Who Fail Hearing Screening: Implications of Otological Problems

“…On the other hand, Pestalozza et al 27,35 believed that the cellular characteristics of middle ear aspi rates in 3-to 5-day-old live newborns sug gested that middle ear infection probably began before birth. This opinion is sup ported by Johnson, 16 who found acute bilateral otitis media in two of four cases of intrauterine pneumonia.…”

“…Therefore, the condition could easily remain undiagnosed, while still posing a threat of damage to the middle ear structures or the possible development of serious complications, such as labyrinthitis or meningitis. 14,16,17 Guggenheim 7 emphasized that unresorbed mesenchyme would tend to interfere with drainage and ventilation of the middle ear.…”

“…Such complications include chronic perforation or atelectasis of the tympanic membrane, tympanosclerosis, adhesions, thickened granular mucoperiosteum, osteoneogenesis, cholesteatoma and inflammatory necrosis, fixation, or discontinuity of ossicles. 12,14,17,30,31 In addition to the acute complications of otitis media, such as labyrinthitis, sepsis, or meningitis, 16,17,29,[31][32][33] and the longterm sequelae, mentioned above, more insidious inner ear disorders may develop, such as high-frequency sensorineural hearing loss, fluctuant hearing loss, and possibly vertigo. 12, ' 17 It is important to keep in mind that otitis media is a very common disorder in early childhood.…”

“…29,47 In early infancy there may occur a spread of purulent infection from an otitis media or from a suppurative meningitis, resulting in profound sensorineural hearing loss. 16,29 At present, there is no medical or surgical cure for sensorineural hearing loss.…”