Refractory otitis media with effusion from viewpoints of eustachian tube dysfunction and nasal sinusitis

doi:10.1016/0196-0709(93)90028-6

American Journal of Otolaryngology

Volume 14, Issue 3, May–June 1993, Pages 187-190

https://doi.org/10.1016/0196-0709(93)90028-6 Get rights and content

Abstract

Introduction: Most children with otitis media with effusion (OME) recover spontaneously before adolescence. However, some children have refractory OME. This study was undertaken to evaluate eustachian tube function and concurrent upper respiratory tract inflammatory conditions in adolescents with refractory OME.

Methods: A group of 83 adolescent patients with refractory OME was identified. Ages range from 10 to 20 years. A control group of 108 children with OME (ages 4 to 9) serve as the basis for comparison. All underwent both passive and active eustachian tube function testing, dye clearance studies, and a sniffing test. Upper respiratory tract inflammation was assessed by roentgenograms of the paranasal sinuses and mucosalivary function.

Results: High-pressure tubal opening was demonstrated in 31% of patients with refractory OME. In contrast, 84% of children with routine OME had normal opening. A marked disturbance of dye clearance was noted in refractory OME cases. Active tubal function during swallowing was disturbed in both adolescent and children's OME groups without any significant difference between them. Paranasal sinusitis was identified in 49% of adolescents with refractory OME. In contrast, 78% of children with OME had abnormality of the sinuses.

Conclusion: Approximately one half of adolescents with refractory OME have demonstrable organic abnormality of the eustachian tube. These data suggest tubal dysfunction may be more important in refractory OME than upper respiratory tract inflammation.

References (3)

B Falk
Sniff-induced negative middle ear pressure; study of a consecutive series of children with otitis media with effusion
Am J Otolaryngol
(1982)

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Cited by (33)

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Citation Excerpt :
The prevalence of OME in children has been estimated in the last three decades in a wide range from 15% to 80% [7–10]. According to a number of studies the presence of sinusitis in children with OME ranges from 48% to 62% [11–13], and concerning the role of allergy some Authors reported that from 23% to 90% of children with OME had hypersensitivity to inhalant allergens [14–17], a range too large to help in clinical practice. We sought to evaluate in children with chronic sinusitis, diagnosed by clinical criteria from a large group of patients with chronic respiratory symptoms, the prevalence of middle ear dysfunction, as assessed by tympanometry, and the prevalence of respiratory allergies.
Due to its anatomical and functional connections, middle ear disorders frequently occur in sinusitis. Its prevalence, however, is likely to be underestimated.
We evaluated the prevalence of middle ear dysfunction, as assessed by tympanometry, in children with chronic sinusitis in a large group of patients with chronic respiratory symptoms, and its possible relationship with respiratory allergy.
From a population of 1810 children with respiratory symptoms referred to our Pediatric Allergy center, subjects with chronic sinusitis diagnosed by clinical criteria were selected. Children underwent testing of middle ear function by tympanometry and of allergy by skin tests with environmental allergens. Patients were divided into three groups according to age.
Two hundred and eighty-eight children (15.9%) had clinical diagnosis of chronic sinusitis according to the established criteria. Twenty-four patients were in group 1, 220 in group 2, and 44 in group 3. Altered middle ear pressure was found in 76.4% of patients, with a significantly higher rate of altered tympanograms in younger children (p < 0.001). A positive skin prick test was found in 29.9% of children, with a significantly higher rate of positivity in older children (p = 0.01).
The decrease with age in the rate of tympanometric alterations is likely to be associated to the anatomic development of the upper airways, while the presence of atopy does not seem to play a role in their occurrence.
Eustachian tube function in older children and adults with persistent otitis media
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Original contributionRefractory otitis media with effusion from viewpoints of eustachian tube dysfunction and nasal sinusitis

Abstract

Am J Otolaryngol

Original contribution
Refractory otitis media with effusion from viewpoints of eustachian tube dysfunction and nasal sinusitis