Ultrastructure of the middle ear mucosa in patients with chronic otitis media with cholesteatoma

Mucosa of the middle ear was obtained from the promontory wall in each of 20 patients during cholesteatoma surgery. Specimens were processed for both scanning and transmission electron microscopy. Non-ciliated mucosal cells were commonly found, with most being secretory cells with secretory droplets and microvilli. The patterns of distribution of microvilli on the surface of these cells were variable. The interciliary spaces were stagnated with secretion. Bacilli were present in five cases. Falloff of mucosal cells was common and intercellular spaces were widened. Compound cilia were observed sporadically. Polymorphic nuclear inflammatory cells, macrophages and fibroblasts appeared in the submucosal area. These findings indicate that although remaining adjacent mucosa after removal of cholesteatoma looks free of disease under the operating microscope, it is actually in a diseased condition with impaired mucociliary function. The cells and bacteria seen microscopically may account for postoperative inflammation, thus warranting continued postoperative antimicrobial medication.