Tubotympanic disease is localized to the mucosa, predominantly in the anteroinferior part of the middle ear cleft.
Disease activity and distribution
•
Healing and destruction occur together. Their relative predominance depends on organism virulence and patient resistance, and acute exacerbations are not uncommon.
•
The perforation involves the pars tensa and is central, with variable size and position.
•
Middle ear mucosa may appear normal when disease is quiescent or inactive; during active disease it becomes oedematous and velvety.
Aural polyp
•
A polyp is a smooth mass of oedematous, inflamed mucosa that protrudes through a perforation into the external canal.
•
The tubotympanic polyp is usually pale, contrasting with the pink, fleshy polyp of atticoantral disease.
Ossicular chain
•
The ossicular chain is usually intact and mobile.
•
Some necrosis may occur, particularly in the long process of the incus.