A comparative study on the nasal endoscopic findings in patients with chronic otitis media
Keywords:Chronic otitis media, Nasopharyngeal pathology, Nasal endoscopy, Inferior turbinate hypertrophy, Adenoid hypertrophy
Background: Nasal and/or sinus disease may well contribute to the development of middle ear disease. In this study, the nasal endoscopic findings in patients with chronic otitis media (COM) compared with a group of people who do not have any otologic relevant disease to evaluate the association of anatomical variations with COM.
Methods: A descriptive comparative study was done. A detailed history, clinical examination and diagnostic nasal endoscopy (DNE) had been done. DNE analysis include eustachian tube blockage, adenoid hypertrophy and inferior turbinate hypertrophy. The results were statistically analysed.
Results: Total 108 cases (45 males and 63 females of age 31.17±14.50 years) and in the control group (48 males and 60 females of average age was 36.06±14.32 years) were included in the study. Most of the COM patients (66.7%) had multiple abnormalities of sinonasal regions compared to controls. Findings of DNE like eustachian tube blockage (p value=0.003), adenoid hypertrophy (p value=0.028) and inferior turbinate hypertrophy (p value=0.035) were significantly associated with chronic otitis media.
Conclusions: Nasopharyngeal pathology causing eustachian tube dysfunction, has higher prevalence among chronic otitis media patients. So early recognition by diagnostic nasal endoscopy is warranted especially when surgery is considered for the comprehensive management of this overwhelming and enigmatic disease.
Aquino JEAP, Cruz Filho NA, de Aquino JNP. Epidemiology of middle ear and mastoid cholesteatomas: study of 1146 cases. Braz J Otorhinolaryngol. 2011;77:341-7.
Sadé J, Konak S, Hinchcliffe R. Cholesteatoma and Mastoid Surgery. Proceedings of 2nd International Conference. Tel-Aviv: Kugler Publications; 1982: 640.
Jahn AF. Chronic otitis media: diagnosis and treatment. Med Clin North America. 1991;75:1277-91.
McPherson B, Holborow CA. A study of deafness in West Africa: the Gambian Hearing Health Project. Int J Pediatr Otorhinolaryngol. 1985;10:115-35.
Daly KA, Hunter LL, Levine SC, Lindgren BR, Giebink GS. Relationships between otitis media sequelae and age. Laryngoscope. 1998;108:1306-10.
Tos M. Causes of the disease. Ann Otolaryngol-Head Neck Surg. 1990;99:7.
Tos M. Sequelae of secretory otitis media and the relationship to chronic suppurative otitis media. Ann Otol Rhino Laryngol. 1990;99:18-9.
Mahoney JL. Mass management of otitis media in Zaire. Laryngoscope. 1980;90:1200-8.
Kenna MA. Treatment of chronic suppurative otitis media. Otolaryngol Clin North Am. 1994;27:457-72.
10. Yuceturk AV, Unlu HH, Okumus M, Yildiz T, Filiz U. The evaluation of eustachian tube function in patients with COM. Clin Otolaryngol. 1997;22:449-52.
Yeolekar AM, Dasgupta KS. Otitis Media:Does the onus lie on sinonasalpathology? Indian J Otol. 2011;17:8-11.
De Souza C, Bhaya M. The role of nasal and sinus surgery in otitis media. Operative techniques in Otolaryngology. Head Neck Surg. 1996;7:16-9.
Bozkus F, Bozan N, Iynen I, Sakin YF, Kiris M. Analysis of sinonasal, pharyngeal and allergy-related risk factors for chronic suppurative otitis media. Acta Medica Mediterranea. 2013;29:47-52.
Bakari AA, Adoga AA, Afolabi OA, Kodiya AM, Ahmad BM. Pattern of chronic suppurative otitis media at national ear care center, Kaduna. J Med Tropics. 2010;12:22–5.
Ibekwe AO. Chronic suppurative otitis media in Nigerian children. J Paediatrics. 1985;12:17–9.
Shrestha D, Thapa P, Bhandari YB. Types of pathology and ossicular status in atticoantral disease undergoing mastoidectomy at Bir Hospital. J College of Med Sci-Nepal. 2010;6:26-30.
Karki R, Rai K. Pattern of Otorhinolaryngological Diseases at Rural Medical Camps in Far Western Region of Nepal. MJSBH. 2012;11:29-31.
Poorey VK, Iyer A. Study of Bacterial Flora in CSOM and its Clinical Significance. Indian J Otolaryngol Head and Neck Surg. 2002;54:91-5.
Nwabuisi C, Ologe FE. Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria. East Afr Med J. 2002;79:202-5.
Ahmad B, Kudi M. Chronic suppurative otitis media in Gombe, Nigeria. Niger J Surg Res. 2004;5:120-3.
Thorp MA, Gardiner IB, Prescott CA. Burow’s solution in the treatment of active mucosal chronic suppurative otitis media: Determining an effective dilution. J Laryngol Otol. 2000;114:432-6.
Adoga A, Nimkur T, Silas O. Chronic suppurative otitis media: Socio-economic implications in a tertiary hospital in Northern Nigeria. Pan Afr Med J. 2010;4:3.
Ferede D, Geyid A, Lulseged S, Melaku A. Drug susceptibility pattern of bacterial isolates from children with chronic suppurative otitis media. Ethiopian J Health Dev. 2001;15:89-96.
Browning GG, Gatehouse S. The prevalence of middle ear disease in the adult British population. Clin Otolaryngol Allied Sci. 1992;17:317–21.
Xu Q, Almudervar A, Casey JR, Pichichero ME. Nasopharyngeal Bacterial Interactions in Children. Emerg Infect Dis. 2012;18:1738–45.
Bakhshaee M, Rajati M, Fereidouni M, Khadivi E, Varasteh A. Allergic rhinitis and chronic suppurative otitis media. Eur Arch Otorhinolaryngol. 201;268:87-91.
Van Cauwenberge PB, Vander Mijnsbrugge AM, Ingels KJ. The microbiology of acute and chronic sinusitis and otitis media:a review. Eur Arch Otorhinolaryngol. 1993;250:S3-6.
Gutierrez-Marcos JA, Fandinoizun-Degui J, Garcia- Palmer R. Deviations of the nasal septum and their relation to tubal physiopathology. Rev Laryngol Otol Rhinol Bord. 1992;113:383-5.
Blue Stone CD: Assessment of Eustachian tube function. In Jerger J (Ed): Handbook of clinical impedance Audiometry, New York, American Electormedics Corporation; 1975: 127-148.
Fujita A, Honjo I, Kuzeta K. Refractory otitis media, organic Abnormalities of euastachain tube dysfunction. Am J Otolaryngol. 1993;14:187-90.
Eryilmaz A, Akmansu H, Dursun E, Dagli M, Acar A, Turkay M, et al. Is there a relationship between chronic rhinosinusitis and otitis media with effusion in pediatric patients? Turk Otolarengoloji Arşivi. 2004;42:164-8.