The role of medical treatment on timing of surgical treatment in draining chronic otitis media

Onur Pakır, The Role of medical treatment on timing of surgical treatment in draining Chronic otitis media, Zonguldak Bülent Ecevit University Faculty of Medicine, Thesis in Ear Nose Throat Diseases - Head and Neck Surgery, Zonguldak, 2015 Objective: To measure the Eustachian tube (ET) mucociliary clearance time (MCT) in actively draining CSOM ears that were in follow up with medical treatment at 1st day, 10th days and 1st month. To compare the results with ET-MCT of at least 3 months dry ears with CSOM. Study Design: Prospective, Tertiary referral center. Patients: Fifty patients (age range:15-60; 26 females and 24 males) with CSOM consisted of 29 patients (group 1; age range: 15-60 years; 16 females and 13 males) with dry ears for at least 3 months and 21 patients (group 2; age range: 17-60 years; 10 males and 11 females ) with draining ears at presentation. The ear pathology in group 1 and 2 included CSOM with no cholesteatoma, no tympanic membrane retraction pockets and no intra tympanic tympanosclerosis. The ET-MCT in group 1 was measured before ear surgery. In group 2, patients were given topical medical treatment and the ET-MCT was measured at the day of presentation and during follow up, at 10th days and 1st month. Interventions: Clinical assessment and mucociliary transport time measurement by saccharin. Main Outcome Measures: The ET mucociliary function was measured by saccharine sodium salt solution 5% (10 μL of 1,1-dioxo-1,2-benzothiazol-3-1). Findings of otoscopic examination of the group 2 patients in each visit were also recorded. Results: The ET-MCT was 8,27±1,52 minutes in dry ears and 28,72±8,26 minutes in draining ears. The difference in the ET-MCT between the 2 groups was statistically significant (p˂0,001). During post medical treatment follow-up of the draining ears, the ET-MCT was 14,53±5,11minutes at 10th days and 9,09±2,33 minutes at 1st month. The ET-MCT in draining eras was significantly shorter at 10th days and 1st month than at 1st day (p<0.001). There was no difference in ET-MCT between dry ears (for at least 3 month) and draining ears at 1st month of post-treatment follow up (p=0.335). Conclusion: The saccharin test is a valuable diagnostic tool to assess the mucociliary function of the ET. In the cases with uncomplicated CSOM, topical treatment is sufficient for recovery. The ET-MCT shows the status of middle ear mucosa. The ET-MCT of draining ears decrease to the values of dry ears after sufficient topical medical treatment in 1 month. Surgical treatment in CSOM cases may be performed in 1 month since ET-MCT improves significantly in 1 month in the course of medical treatment. Key Words, Eustachian tube, mucociliary clearance, chronic otitis, saccharine test, tympanoplasty