The outset of chronic secretory otitis media: a histopathological study of the earliest stage.

Histopathological study of the earliest stage of secretory otitis was made in a 3-month-old infant. The entire mucosa was examined by the whole-mount method, with determination of gland count and goblet-cell density, followed by assessment of serial sections. The first changes are inflammatory with lymphocytic infiltration, dilatation, and increase of blood vessels. These again induce metaplasia into pseudostratified, ciliated epithelium, increased in goblet-cell density, and formation of intraepithelial and subepithelial mucous glands. Basal cells divide and grow down into lamina propria, giving rise to a solid cylinder that gets canalized. Cells of this cylinder differentiate into ciliated and mucous cells, so that tubules acquire a lining of typical pseudostratified, ciliated, columnar epithelium. The most important processes in the early stage of secretory otitis are hyperplasia, differentiation of epithelial cells, and gland formation. When glands have completed their development, they produce mucus that accumulates in the middle ear, and the disease enters the secretory stage.