Presentation
Bilateral chronic middle ear disease with perforated tympanic membranes and reduced hearing especially on the left.
Patient Data
Soft tissue density material in both middle ear clefts entering the mastoid antra with minimal erosion of the right scutum. Complete loss of ossification in the right ossicular chain with residual casts rather than bone erosion and replacement (note assymetry with the left)
Case Discussion
Chronic suppurative otitis media (CSOM) is a chronic infective process (> 6 months duration) due to chronic tympanic membrane perforation with drainage of purulent material into the external canal.
Ossicular chain deossification is a recognized phenomenon in CSOM and is thought to be due to an enzymic reaction produced by bacteria rather than true bone erosion/replacement that occurs in cholesteatoma. As in this case it can co-exist with cholesteatoma (as evidenced by scutal erosion)