Evaluation of the osteonecrosis in chronic supurative otitis media with eletron microscopy

Aim: There are many theories about bone destruction in chronic otitis media, by the way bone erosion could not be defined clearly yet. In this study, we aimed to evaluate the osteonecrosis in chronic otitis media with electron microscopy.Material and method: In this study, pathological tissue samples of 20 patients who are operated between january 2007 and november 2007 in Çukurova University ENT Department; were examined with electron microscopy. The samples of cholesteatoma, granulation tissue, incus and mastoid tissue were examined under JEOL-JEM 1400 transmission electron microscopy.Results: In 16 of these patients both incus and mastoid bone; and rest of 4 patients only mastoid bone due to lack of ossicles were used as tissue samples for electron microscopic examination.. In 14 of patients; cholesteatoma, and in 6 of patients granulation tissue was observed in middle ear and/or mastoid cells. Bone destruction was observed in middle ear ossicles in 13 of 14 (%92,8) patients who have chronic otitis media with cholesteatoma, and 3 of 6 (%50) patients who have chronic otitis media without cholesteatoma. On samples obtaining from patients who have chronic otitis media with cholesteatoma, bone irregularity, erosion and also hypervascularity and dense cellular infiltrations were observed. Also enlarged endoplasmic reticulum, vacuoles in cytoplasms in these media cells are the findings that are supporting enzymatic theory. On the incus spescimens; degenerative changes in the ossicle cells and wide vacuoles in cytoplasms were observed.Conclusion: In the light of these findings incus should not be used as a greft material in patients with cholesteatoma. Whether this study is not accurately explaining the enzymatic theory, but this may shed the light to studies on future and investigating the osteonecrosis.