The Pathogenesis of Chronic Secretory Otitis Media

In a patient with mild chronic secretory otitis media, 488 abnormal mucous glands were found in the mucous membrane of the osseous eustachian tube and middle ear. Of these glands, 188 were active, 102 were transitional, and 198 were degenerated. The glands are described and their secretory capacity calculated. On the basis of these studies a new pathogenesis of chronic secretory otitis is presented and discussed. Owing to the influence of etiological factors, transformation of the epithelium with gland formation occurs. When the glands have completed their development they start forming mucus, which slowly accumulates in the middle ear. When the majority of the glands have started degenerating, the mucus production decreases and the disease improves spontaneously, provided that adhesive otitis has not arisen. The therapeutic program consists of (1) prevention of gland formation (2) intubation and (3) long-term follow-up of the patients.