Healed otitis media is the end result of episodes of acute otitis media or otitis media with effusion. It can also result from the natural healing of the ear with mucosal or squamous chronic otitis media. The usual outcome of healed otitis media is a stable ear, but in some cases tympanosclerosis can affect the ossicular chain and cause hearing impairment. Progression can occur through reperforation of the tympanic membrane from subsequent infections or trauma. Hearing is often normal or mildly impaired in healed otitis media, but can be more significantly impaired if there is ossicular damage, fixation, or cochlear damage from previous infections. Management

1. Healed Otitis Media
Heal otitis media may be the end result of episodes of acute otitis media or otitis media with
effusion.It may also be the end result of natural healing of ears with either musosal or squamous
COM.It is also the aim of surgery in most cases of COM irrespective of its type or activity.
Progression of Healed otitis media
The usual out come in healed otitis media is a stable ear which does not accumulate debris and in
which the hearing impairment does not increase.
In a few cases , tympanosclerosis affects the ossicular chain, particularly in attic.
The incidence of the tympanosclerosis in all cases of COM is estimated at 25%.
It is thought that tympanoslerosis occurs less commonly in squamous epithelial disease & in active
mucosal disease.
Progression towards activity
Reperforation of the TM may occur if there is a subsequent episode of acute otitis media or
trauma.Episodes of acute otitis media are most likely to occur in children & may occur in adults. TM
rarely heals normally.
Although the TM may heal to a state of intactness,the supporting fibrouse layer of the drum fail to
regenerate,resulting in a thin scar at site of the previous perforation or indeed the whole TM may
be thin & attenuated.
If ETD persist >drum becomes retracted>may become draped over & adhere to the structures in
the medial wall of the middle ear, a condition known adhesive otitis media.
Hearing in healed otitis media
The hearing of the healed otitis media may be normal or there may be a mild conductive hearing
impairment unless there is ossicular damage or fixation. There may be SNHL ,as a result of cochlear
damage related to previous infection.
Presentation
The patients with healed otitis media may present with a hearing impairment. In elderly patients ,it
is commonly an incidental finding when they present with age related hearing impairment.
Examination
Diagnosis is made on otoscopy.
PTA: many patients have minimal air-bone gap,but in ears where there is fixation of the ossicular
chain by tympanosclerosis or by adhesive otitis media or erosion of long process of incus,air-bone
gap can be upto 60db.

2. Management
Management is only indicated in the presence of significant hearing disability& hearing aids should
always be considered.
Surgery : success rate limited.As hearing impairment is usually the sole symptom ,hearing aids often
the optimal management option.