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Adult-onset otitis media with effusion: results following
ventilation tube insertion
M. W. Yung, Ph.D., F.R.C.S., D.L.O., R. Arasaratnam, F.R.C.S., D.L.O.
Abstract
The outcome of otitis media with effusion (OME) in children is generally good. However, it is less clear in
adults. All adult patients who had a ventilation tube inserted for OME at the Ipswich Hospital between
1996 and 1997 were studied. Of 53 patients studied, 28 had had a previous history of ventilation tube
insertion. Furthermore, at 1527 months following ventilation tube insertion, the ventilation tube had
already extruded in 31 patients and the OME had already recurred in 19 of these. Endoscopic
examination revealed that many patients still had evidence of inammation at the lateral nasal wall (26.4
per cent) and at the eustachian tube orice (51 per cent). There is also a strong history of atopy in the
studied group and the skin prick test was positive in 57 per cent of the patients. This study shows that
many patients with adult-onset OME have underlying pathology that could lead to recurrence of OME
following ventilation tube extrusion.
Key words: Otitis Media with Effusion; Middle Ear Ventilation
Introduction
Otitis media with effusion (OME) is one of the
commonest causes of paediatric referral to an otolaryngologist. While it is accepted that most OME in
children resolves with time, a signicant number of
cases still result in ventilation tube insertion. It has
been reported that 70 per cent of children had
complete resolution of OME following one ventilation
tube insertion and a further 20 per cent resolution
1
following a second ventilation tube insertion. On the
whole, most clinicians agree that most children with
OME have a good outcome, mainly as a result of the
natural resolution of the disease.2
The outcome of adult-onset OME is less wellestablished. It is known that OME secondary to
nasopharyngeal carcinoma will not respond well to
ventilation tube insertion and will very often result in
persistent discharge through the tube.3
The aim of the present study is to examine the
outcome of ventilation tube insertion in patients with
non-tumour related adult-onset OME. Any underlying nasal, nasopharyngeal and atopic factors will
also be examined.
From the Department of Otolaryngology, The Ipswich Hospital NHS Trust, Ipswich, UK.
Accepted for publication: 14 June 2001.
874
875
adult-onset otitis media with effusion: results following ventilation tube insertion
TABLE I
surgical outcome of 53 adult patients suffering from
chronic otitis media with effusion (ome) 15 to 27 months
following ventilation tube (vt) insertion
Outcome
Number of
patients (n = 53)
VT still in situ
VT already extruded
Recurrence of OME following VT extrusion
Persistent/recurrent discharge from VT
22
31
19
4
TABLE II
nasal endoscopic ndings of 53 adult patients suffering from chronic otitis media with effusion (ome) at 15 to 27 months
following ventilation tube (vt) insertion
Patients with VT extruded (n = 31)
Recurrence of
OME
(n = 19)
No recurrence
of OME
(n = 12)
Patients with
VT still in situ
(n = 22)
39
5
11
12*
1*
7*
9*
2*
1*
18
2
3
Note: *Comparing normal and abnormal endoscopic nding between the OME recurrence group and No recurrence group using
Yates-corrected Chi-squared test, p>0.5.
876
m. w. yung, r. arasaratnam
TABLE III
appearance of eustachian tube ori ce of 53 adult patients suffering from chronic otitis media with effusion (ome) at 15 to
27 months following ventilation tube (vt) insertion
Patients with VT extruded (n = 31)
Recurrence of
OME
(n = 19)
No recurrence
of OME
(n = 12)
Patients with VT
still in situ
(n = 22)
26
12
20
8*
8*
7*
8*
0*
4*
10
4
9
Note: *Comparing the normal and abnormal appearance at the ET orice between the OME recurrence group and No recurrence
group using Pearson Chi-squared statistic, p>0.05.
TABLE IV
symptoms of chronic rhino-sinusitis in correlation to the nasal endoscopic ndings in 53 adult patients with chronic otitis
media with effusion (ome)
8
2
9
30
3
2
877
adult-onset otitis media with effusion: results following ventilation tube insertion
TABLE V
skin prick test results and serum ige level of 53 adult patients suffering from chronic otitis media with effusion (ome) at 15
to 27 months following ventilation tube (vt) insertion
Patients with VT extruded (n = 31)
Recurrence of
OME (n = 19)
No recurrence of
OME (n = 12)
Patients with VT
still in situ (n = 22)
30
23
7
46
10*
9*
4**
15**
5*
7*
2**
10**
15
7
1
21
878
m. w. yung, r. arasaratnam
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Address for correspondence:
Mr M. W. Yung,
Department of Ear, Nose and Throat,
The Ipswich Hospital NHS Trust,
Heath Road, Ipswich,
Suffolk IP5 4PD, UK.
Fax: 01473 287 135
E-mail: yung@doctors.org.uk
Mr M. Yung takes responsibility for the integrity of the
content of the paper.
Competing interests: None declared