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[Otitis media with effusion: a study of 346 cases in an outpatient clinic]
1Ogawa Ear, Nose and Throat Clinic, Tokyo.
Insights
Otitis media with effusion (OME) treatment outcomes varied by age, with children often benefiting from paracentesis or grommets. Nasopharyngeal infections and allergies are linked to OME development in both children and adults.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Epidemiology
Context:
- Otitis media with effusion (OME) and recurrent acute suppurative otitis media are common conditions, particularly in children.
- Understanding treatment efficacy and contributing factors is crucial for effective management.
Purpose:
- To analyze treatment outcomes for otitis media with effusion (OME) and recurrent acute suppurative otitis media in different age groups.
- To identify potential predisposing factors for OME, including infections and allergies.
Summary:
- A 6-year study treated 346 OME and 127 recurrent acute suppurative otitis media episodes.
- In children (<15 years), 40% improved with conservative management, 49% with paracentesis, and 11% with grommets.
- In adults (≥15 years), 2% improved conservatively, 87% with paracentesis, and 7% with grommets.
- Bilateral OME was more common in children (30%) and associated with persistence/recurrence.
- Upper respiratory tract infections, rhinosinusitis, and allergic rhinitis were frequently observed, suggesting nasopharyngeal factors contribute to OME.
- Acute purulent otitis media progressed to OME in 22% of children versus 3% of adults.
Impact:
- Treatment success rates differ significantly between pediatric and adult populations with OME.
- Identifying nasopharyngeal infections and allergies as risk factors can inform preventative strategies.
- Findings suggest a common underlying factor for OME and recurrent suppurative otitis media in children.
Abstract:
We treated 346 patients with otitis media with effusion (OME) and 30 (127 episodes) with recurrent acute suppurative otitis media at our outpatient clinic in the 6 years from October 1994 to September 2000. Of these, children under 15 years old numbered 185, mostly boys at a ratio of 1.4: 1.0, while patients aged 15 years or older numbered 161, mostly females at a ratio of 1.3: 1.0. In children, 24 were excluded due to a lack of diagnostic follow-up, 65 (40%) patients improved in conservative management of medication with and without repeated tubal inflation, 79 (49%) improved by paracentesis, and 18 (11%) recovered with the use of pressure equalization tubes (grommets). Of cases aged 15 years or older, follow-up was not possible in 28. Three (2%) were free of OME by conservative treatment, 116 (87%) improved by paracentesis, and 9 (7%) by using tubes. The mean durations of tube insertion was 11.3 months in children and 7.2 months in adults, but 5 adults (4%) continue being treated of this writing. Bilateral cases were 30% of children and 8% of adults with 73% of children affected bilaterally having persistence or recurrence. Acute purulent otitis media progressed to OME in 22% of children but only in 3% of patients aged 15 or older. In 36% of children and 26% of patients aged 15 or older, acute upper respiratory tract infection coincided with or predisposed to OME. Rhinosinusitis was seen in 19% of children and 14% of adults. Coincident allergic rhinitis was seen in 14% of children and 12% of adults with OME. Nasopharyngeal infection and allergy are likely related to OME development. The peak incidence of OME was similar to that of recurrent suppurative otitis media in children, so a seminal precipitating factor appears to result in these 2 conditions.