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

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.

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.

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.

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.