Abstract
Purpose
To investigate if pathologies causing upper airway obstructions are correlated with chronic otitis media.
Materials and methods
One hundred fourteen patients with chronic otitis media and 114 healthy controls were enrolled in this study. Nasal septal deviation, Friedman and Mallampati scores were assessed for upper airway obstructions. Chronic suppurative otitis media was classified into tubotypmanic ( n = 80) and atticoantral ( n = 34) subtypes. Number of patients with septal deviation with a convexity to the same side as the affected ear in each CSOM subgroup was compared with chi-square test. The mean Mallampati and Friedman scores in tubotympanic disease group, atticoantral disease group and healthy controls were compared using Kruskal–Wallis test.
Results
Septal deviation occurred more frequently on the same side of ear pathology in patients with tubotympanic chronic suppurative otitis media ( p = 0.0005). Such a difference was not observed between the controls and patients with atticoantral chronic suppurative otitis media ( p = 0.718). No significant difference was noted between patients and controls in terms of Mallampati and Friedman scores ( p = 0.602 and p = 0.836, respectively). Subtypes of chronic suppurative otitis media were not different from each other in terms of Mallampati and Friedman scores either ( p = 0.718 and p = 0.708).
Conclusion
Our results indicate that septal deviations may commonly occur on the same side with chronic otitis media. Therefore, septal deviations must be carefully investigated during the preoperative assessment of patients with CSOM. Elucidation of any possible causal relationship calls for further trials in larger series.
1
Introduction
1.1
Purpose
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid mucosa accompanied by perforation of the tympanic membrane and discharge . Despite the improvements in patient care and medical technology, medical and surgical treatment options for CSOM still have substantial failure rates .
Septal deviation (SD), palatine tonsil hypertrophy (PTH), and enlargement of base of the tongue (EBT) are common causes of upper airway obstructions. To our knowledge, the association of upper airway obstructions with tubotympanic and atticoantral subtypes of CSOM had not been studied up to now.
A few postulates had been speculated on the association of SD with CSOM. Septal deviation can interfere with Eustachian tube function and therefore may not only be involved in CSOM but also may worsen surgical outcomes. Inflammatory disorders of middle ear are suggested to be related with inadequate ventilation through Eustachian tube (ET). In other words, pathological processes involving nasal cavity and paranasal sinuses may disturb ET function . The decrease in air influx through Eustachian tube may lead to diminished aeration of middle ear cavity. This may be the initiation of subsequent reactions contributing to the development of chronic otitis media. Septal deviations may cause tubal diysfunction and middle ear depression subsequently. Similarly, correction of an SD may reduce the tubal opening pressure and can interrupt the process leading to CSOM . Many authors believe that nasal surgery should be performed prior to tympanoplasty for patients with CSOM, since nasal surgery can provide proper Eustachian tube function and help to achieve more satisfactory outcomes from middle ear surgery consequently. On the other hand, a septoplasty before tympanoplasty cannot be recommended routinely to all patients with CSOM and SD. It is suggested that ET tube function must be assessed to decide the necessity of nasal surgery before tympanoplasty . However, to our knowledge a separate assessment for tubotympanic and atticoantral subtypes of CSOM and SD had not been performed in the literature.
Palate and the base of tongue are two common locations for upper airway obstructions. Friedman and Mallampati scores are two measures developed to scale the degree of obstruction at these locations . Involvement of paratubal muscle function in PTH and EBT may be involved in pathogenesis of CSOM due to possible disturbance of ET function . Therefore, we aimed to investigate if patients with PTH and EBT of tongue were more likely to suffer from CSOM.
All in all, this study was performed to investigate any correlation between upper airway obstructions (such as septal deviation, hypertrophy of the palatine tonsils, and enlargement of the base of the tongue) and chronic suppurative otitis media.
2
Methods
This prospective study was conducted in Karadeniz Technical University, School of Medicine, Department of Otorhinolaryngology and Ruhr University, School of Medicine, St. Elisabeth’s Hospital, Department of Otorhinolaryngology between December 2009 and January 2011. This study was approved by the local institutional review board (report no. 2009/72) and was performed in accordance with the principles of the Helsinki Declaration. Written informed consent was obtained from all patients prior to involvement in the study. In this study, 113 patients with chronic otitis media (male, female) and 114 controls (male, female) were assessed in terms of SD, PTH and EBT. Patients with bilateral CSOM, and those with a history of nasal, middle ear or oropharyngeal surgery were excluded from this study. Septal deviation was assessed via anterior rhinoscopy, and nasal endoscopy. Three groups were formed with respect to the assessment for septal deviation: i) convexity to the same side with affected ear, ii) septal deviation with convexity to the other side than the affected ear, or iii) no septal deviation. Friedman and Mallampati scores were derived from oropharyngeal examination findings .
Septal deviation was diagnosed via anterior rhinoscopy and nasal endoscopic examination. In addition, temporal CT scans allowed visualization of the axis of the nasal septum.
Chronic suppurative otitis media patients were subdivided into two subgroups with respect to otomicroscopy and temporal bone computerized tomography findings: i) tubotympanic disease and ii) atticoantral disease . These subgroups were compared in terms of occurence of septal deviation, Mallampati scores and Friedman scores. Results for septal deviation were compared using chi-square test, whereas Kruskall–Wallis test was performed for the comparison of Mallampati and Friedman scores.
2
Methods
This prospective study was conducted in Karadeniz Technical University, School of Medicine, Department of Otorhinolaryngology and Ruhr University, School of Medicine, St. Elisabeth’s Hospital, Department of Otorhinolaryngology between December 2009 and January 2011. This study was approved by the local institutional review board (report no. 2009/72) and was performed in accordance with the principles of the Helsinki Declaration. Written informed consent was obtained from all patients prior to involvement in the study. In this study, 113 patients with chronic otitis media (male, female) and 114 controls (male, female) were assessed in terms of SD, PTH and EBT. Patients with bilateral CSOM, and those with a history of nasal, middle ear or oropharyngeal surgery were excluded from this study. Septal deviation was assessed via anterior rhinoscopy, and nasal endoscopy. Three groups were formed with respect to the assessment for septal deviation: i) convexity to the same side with affected ear, ii) septal deviation with convexity to the other side than the affected ear, or iii) no septal deviation. Friedman and Mallampati scores were derived from oropharyngeal examination findings .
Septal deviation was diagnosed via anterior rhinoscopy and nasal endoscopic examination. In addition, temporal CT scans allowed visualization of the axis of the nasal septum.
Chronic suppurative otitis media patients were subdivided into two subgroups with respect to otomicroscopy and temporal bone computerized tomography findings: i) tubotympanic disease and ii) atticoantral disease . These subgroups were compared in terms of occurence of septal deviation, Mallampati scores and Friedman scores. Results for septal deviation were compared using chi-square test, whereas Kruskall–Wallis test was performed for the comparison of Mallampati and Friedman scores.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
