Complications
A spectrum of disorders that represents the end result of prolonged impairment of middle ear aeration.[45] The increased negative pressure in the middle ear cleft causes retraction of the tympanic membrane. This typically occurs in the pars flaccida area of the eardrum, but can occur throughout. The resulting retraction pocket may turn into a cholesteatoma, a keratin-filled inflammatory cyst that can erode the middle ear anatomy and lead to permanent hearing loss and additional complications. These patients should be managed by an otolaryngologist with expertise in otology.
Sustained negative pressure in the middle ear cleft may lead to accumulation of serous exudate from the middle ear mucosa. This may resolve spontaneously, though if prolonged may benefit from tympanostomy.[45]
Occurs because patients are unable to equalize pressure within the middle ear with sudden atmospheric pressure change, as occurs in airplane flight, diving, or driving up or down steep inclines. Injection, hemorrhage, or perforation of the tympanic membrane may be observed, as well as free blood or bubbles in the middle ear.
Acute infection may occur if stagnant middle ear secretions become infected. This is typically a bacterial process, though the necessity of antibiotics is not universally agreed upon.[45]
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