Inflammatory Endotypes of Chronic Adenoiditis and Their Impact on Persistent Middle Ear Dysfunction: A 2-Year...

Area of Science:

• Pediatric Otorhinolaryngology
• Inflammatory Diseases
• Biomarkers

Background:

• Chronic adenoiditis is a key cause of persistent middle ear dysfunction (PMED) in children.
• Clinical outcomes vary despite similar anatomical obstruction.

Purpose of the Study:

• Identify inflammatory endotypes of chronic adenoiditis using unsupervised clustering.
• Evaluate endotype association with PMED through mechanistic and predictive modeling.

Main Methods:

• Retrospective analysis of 236 children (3-12 years) with chronic adenoiditis and otitis media with effusion.
• K-means clustering for endotype identification; multivariate logistic regression and mediation analysis for PMED association.
• Machine learning models (logistic regression, random forest, gradient boosting) for predictive performance evaluation.

Main Results:

• Three endotypes identified: eosinophilic (28%), neutrophilic (41%), and fibrotic-obstructive (31%).
• Fibrotic endotype showed higher PMED rates (44%) vs. eosinophilic (22%).
• Fibrotic endotype independently predicted PMED (OR=3.48); hearing impairment mediated 34% of obstruction's effect.

Conclusions:

• Chronic adenoiditis presents distinct inflammatory endotypes with varying PMED risks.
• Integrating inflammatory profiling and machine learning enhances understanding and risk stratification.
• Precision-based management strategies can be supported for pediatric otorhinolaryngology.