A STUDY ON INFLUENCE OF CHRONIC SINUSITIS ON MUCOSAL ACTIVE TYPE OF CHRONIC OTITIS MEDIA IN A TERTIARY CARE HOSPITAL, HYDERABAD

Abstract

Introduction: Chronic Suppurative otitis media is one of the most frequently encountered diseases in ENT. CSOM affects over 300 million individuals over the globe of which 60% suffer from significant hearing loss. In India, the overall prevalence is 46 and 16 per 1000 in rural and urban population respectively. Chronic suppurative otitis media (COM) is defined as chronic inflammation of mucoperiosteal lining of the middle ear cleft. It is associated with history of ear discharge for more than 3 months and a permanent tympanic membrane defect. The most important pathological factors in CSOM are dysfunction of the Eustachian tube and bacterial infection. The mucosal type of chronic suppurative otitis media is usually associated with co-existent sinus and nasal pathology which can worsen middle ear problems due to eustachian tube dysfunction.

Materials and Methods: A cross-sectional study is carried out in department of Otorhinolaryngology where the study population involves patients with active mucosal type of CSOM who sought treatment at Government ENT Hospital, Koti for a period of 18 months. A total of 50 patients of age >18 years who presented to OPD with complaints of persistent ear discharge for >2 months and with conductive hearing loss of 20-40 dbHL, were selected and were subjected to detailed history, Physical examination, and complete ENT examination. Patients then underwent Otoendoscopic examination and Diagnostic Nasal Endoscopy, and radiological evaluation like, Xray mastoids and CT paranasal sinuses. Routine investigations are carried out in all patients as well as Pure Tone Audiometry. Patients with evidence of chronic sinusitis were treated with antibiotics, antihistamines and decongestions for a period of at least 6 weeks.

Results: A total of 50 patients were selected for the purpose of this study. These patients with active mucosal type of chronic otitis media had persistent ear discharge even  following  culture  directed  topical  and systemic antibiotics. These patients had cellular type of mastoids on x- ray/CT temporal bones. This study emphasizes sinus pathology as a major factor for persistently active mucosal type of chronic otitis media. The percentage other septic foci like chronic tonsillitis, adenoids is less in comparison to sinus disease. This study was conducted over a period of 18 months in 50 patients of which 18 were males and 32 were females. Majority of the patients belonged to age group 18 – 30 years. Amongst these patients, 31 came from rural region and 19 from urban areas. The poor living conditions in rural population can be considered as one of the predisposing factor for the higher prevalence in this population.

Conclusion: In the adult population sinusitis is one of the most important cause of persistent ear discharge in mucosal type of Chronic otitis media. Assessment for sinusitis in the treatment of Chronic otitis media should become a routine practice. In the evaluation of the patients with chronic otitis media, radiological, endoscopic, and other diagnostic tools have their roles in the assessment of the patients, and to rule out nasal and paranasal pathologies as potential aetiological factors. Deviated nasal septum, Concha bullosa and enlarged bulla ethmoidalis in order of frequency are the most common anatomical variants of nose and paranasal sinuses predisposing to sinusitis. Unilateral ear discharge is associated with sinusitis only on the corresponding side, which is in concurrence with our study.