March 19, 2008 — Patients with chronic otitis media (COM) in 1 ear are highly likely to have structural or other abnormalities in the contralateral ear, according to the results of a study reported in the March issue of the Archives of Otolaryngology—Head & Neck Surgery.

"According to the continuum theory, OM with effusion (OME) is recognized as the initial condition that, when unresolved, may progress to chronic transformation," write Sady Selaimen da Costa, MD, PhD, from the Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, and colleagues. "Although only a small percentage of the ears with OME will evolve to have COM, our question is this: Considering that the presence of bilateral effusion is reported to be high, should not the prevalence of bilateral COM be similarly prevalent?. . . . The current study reports the characteristics of the contralateral ear (CLE) in a series of patients with COM with the specific objectives of (1) studying the existence of pathologic changes in the CLE of patients with COM and (2) comparing findings in patients with COM with cholesteatoma vs those without."

At a tertiary referral center, 500 consecutive patients diagnosed with COM with or without cholesteatoma underwent digital otoendoscopy on both ears. The primary endpoint was pathologic alterations in the CLE.

Structural abnormalities were found in the CLE in 75.2% of the patients. COM without cholesteatoma was present in 60.4% of the patients, and in this group, 69.9% had abnormal findings in the CLE. In patients with cholesteatoma, 83.3% had abnormal findings in the CLE. Retraction of the tympanic membrane was the most common finding in both groups.

"Patients with COM in 1 ear have a high chance of presenting with some degree of disease in the contralateral side," the study authors write. "We believe that our findings suggest that COM should be ideally approached not as a static pathological incident affecting 1 ear but rather as an ongoing process that may affect both ears.... The CLE should always be comprehensively studied in patients with unilateral COM to efficiently diagnose the alterations and, if necessary, provide timely therapeutic intervention."

The study authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. 2008;134:290-293.

Clinical Context

Study Highlights

• 500 consecutive patients diagnosed with COM were enrolled at a tertiary referral center for 6 years.
• Definition of COM was chronic inflammation of the middle ear, mastoid, or both, plus permanent perforation or retraction of the tympanic membrane with or without otorrhea.
• Patients who had previous otologic surgery, excluding placement of a ventilation tube, were excluded.
• Mean age of the patients was 26.3 years (SD, 17; age range, 2 - 82 years).
• 51% were male sex.
• Patients underwent otoscopy, otoendoscopy, otomicroscopy, and pure tone and speech audiometry.
• Video recordings of both ears were reviewed to categorize endoscopic findings as normal vs abnormal and to categorize primary pathologic findings of effusion, retraction, perforation, cholesteatoma, or tympanosclerosis.
• Definition of cholesteatoma was perforation or retraction of the tympanic membrane with keratin retention with or without granulation and recurrent inflammation.
• The CLE was defined as an asymptomatic ear or an ear with less symptoms of hearing loss, otorrhea, and discomfort.
• Of 500 patients, 376 (75.2%) had abnormalities in the CLE.
• The most common abnormal findings were retraction of the tympanic membrane in 38.2%, perforation of the tympanic membrane in 26.2%, cholesteatoma in 5.2%, tympanosclerosis in 3.6%, and fluid in the middle ear in 2.0%.
• Of 302 (60.4%) patients without cholesteatoma, 69.9% had abnormalities in the CLE:
  • Perforation of tympanic membrane (30.8%)
  • Retraction of tympanic membrane (30.1%)
  • Tympanosclerosis (6.0%)
  • Fluid in middle ear (3.0%)
• Of 198 (39.6%) patients with cholesteatoma, 83.3% had abnormalities in the CLE:
  • Retraction of tympanic membrane (50.1%)
  • Perforation of tympanic membrane (19.3%)
  • Cholesteatoma (13.3%)
  • Fluid in middle ear (0.6%)
• Subanalysis restricted to moderate and severe tympanic membrane retractions, perforation, and cholesteatoma showed abnormalities in the CLE in 55.8% of patients and more abnormalities in patients with vs without cholesteatoma (68.6% vs 43.0%; P < .001).
• In patients with COM and cholesteatoma, the most common degree of retraction of the contralateral tympanic membrane was severe (24.7%), followed by mild (14.1%) and moderate (11.2%).
• In patients with COM without cholesteatoma, the most common degree of retraction of the contralateral tympanic membrane was mild (17.9%), moderate (8.6%), and severe (3.6%).

Pearls for Practice

• In patients with COM, the prevalence of pathologic findings in the CLE is 75.2%; the most common finding is retraction of the tympanic membrane.
• In patients with COM, pathologic findings in the CLE are found in 69.9% of patients without cholesteatoma (most common findings being perforation and retraction of the tympanic membrane) and 83.3% of patients with cholesteatoma (most common finding being retraction of the tympanic membrane).

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