Electron microscopic imaging of osteonecrosis in chronic supurative otitis media

Objective: In this study, we aimed to demonstrate electron microscopiccellular changes of bone necrosis developing due to chronic otitis media. Material and Methods: This study was performed on the pathologic tissue samples of 20 cases that were operated due to chronic supurative otitis media in Çukurova University Ear Nose Throat Department. Collected cholesteatoma tissue samples, granulation tissue samples, incus and mastoid bone samples were examined by JEOL-JEM 1400 transmission electron microscopy after dyeing. Results: Incus and mastoid bone were examined together in 16 of the operated patients. In the remaining 4 patients, only mastoid bones were examined as the ossicles were absent. Fourteen patients showed cholesteatoma in the middle ear and/or mastoid cellulae, and 6 patients showed granulation tissue. Middle ear ossicles were corroded in 13 of 14 (92.8%) patients with chronic otitis media and cholesteatoma versus 3 of 6 (50%) patients with chronic otitis media without cholesteatoma. In the samples of patients with chronic otitis media and cholesteatoma, ossicles were irregular, besides increase in vascularity; dense cellular infiltration was also observed. Swollen endoplasmic reticulum and cytoplasmic vacuoles are among the findings that support the enzymatic theory. Examination of incus samples revealed degenerative changes and large vacuoles in cells. Conclusion: This study was not able to demonstrate enzymatic theory, it may shed light on further studies focusing on osteonecrosis. © 2005 The Mediterranean Society of Otology and Audiology