Pathogenesis and pathology of chronic secretory otitis media.

Secretory otitis media is divided into three stages, and the pathogenesis and pathology of each stage are described on the basis of quantitative histopathological studies. In the initial stage, ie, the period before accumulation of mucus in the middle ear, metaplasia causes a transformation of the mucosa into a secretory mucosa and mucous glands are formed. These processes are described in detail. In the secretory stage, which is the period with accumulation of mucus in the middle ear, an enormous increase was found in the density of goblet cells and the density of active mucous glands was large. In the degenerative stage, the production of secretion abates owing to degeneration of the glands. These become inactive, and the mucosa gradually normalizes. The normalization process is slow and runs through several turnover periods of the epithelium by means of a gradually decreasing rate in the division of the basal cells.