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The Contralateral Ear in Chronic Otitis Media

Article in Archives of Otolaryngology - Head and Neck Surgery · April 2008

DOI: 10.1001/archoto.2007.38 · Source: PubMed

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Cristina Dornelles
Universidade Federal do Rio Grande do Sul
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 ORIGINAL ARTICLE

The Contralateral Ear in Chronic Otitis Media

A Series of 500 Patients
Sady Selaimen da Costa, MD, PhD; Letı´cia Petersen Schmidt Rosito, MD, MS;
Cristina Dornelles, MS; Neil Sperling, PhD

Objective: To study the contralateral ear of patients
with chronic otitis media (COM).
Design: Transversal.
Setting: Tertiary referral center.
Patients: A total of 500 consecutive patients who
had been diagnosed as having COM with or
without cholesteatoma.
Interventions: Digital otoendoscopy was performed
Results: In 75.2% of the patients, the contralateral
ear was found to have some structural abnormalities;
60.4% of the patients presented with COM without
cholestea- toma, and in this group, 69.9% had an
abnormal contra- lateral ear. In those with
cholesteatoma, the contralat- eral ear was found to
be abnormal in 83.3%. The most frequent finding in
both groups was retraction of the tym- panic
membrane.
Conclusions: Patients with COM in 1 ear have a
high chance of presenting with some degree of
disease in the contralateral side. We believe that

C
on both ears. our findings suggest that COM should be ideally
approached not as a static pathological incident
Main Outcome Measure: Pathologic alterations in affecting 1 ear but rather as an on- going process that
the contralateral ear. may affect both ears.

Arch Otolaryngol Head Neck Surg. 2008;134(3):290-293

Author Affiliations:
Department of
Otolaryngology–Head and
Neck Surgery, Universidade
Federal do Rio Grande do Sul,
Porto Alegre, Brazil
(Drs Selaimen da Costa and
Rosito and Ms Dornelles);
Otological Division,
Hospital Mãe de Deus,
Porto Alegre (Dr Selaimen
da Costa and
Ms Dornelles); and Division
of Otology, Department of
Otolaryngology, State
University of New York,
Downstate Medical Center,
Brooklyn
(Dr Sperling).
HRONIC OTITIS MEDIA
(COM) undoubtedly
rep- resents one of the
main areas of interest
within modern
clinical otology
considering the great variety of
research material recently published on
this topic.1-8 Among its multiple facets,
perhaps the paramount issue
concerning COM is its pathogenesis.
We have followed the patho- genesis
model suggested by the Minne-
apolis group 4,9,10 —the so-called
con- tinuum theory. According to this
theory, otitis media (OM) seems to
exist through a continuous series of
epithelial and sub- epithelial events,
and, after the initial trig- gering
episode, a serous or purulent oti- tis
becomes serous-mucoid, then mucoid,
and, in the absence of therapeutic
resolu- tion, chronicity may ensue.
According to the continuum theory,
OM with effusion (OME) is
recognized as the initial condi- tion
that, when unresolved, may progress
to chronic transformation. Although
only a small percentage of the ears
with OME
will evolve to have COM, our question
is this: Considering that the presence
of bi- lateral effusion is reported to be
high,11 should not the prevalence of
bilateral COM be similarly prevalent?
Based on such reasoning and the
lim- ited data available in the
literature,12,13 the current study reports
the characteristics of the contralateral
ear (CLE) in a series of patients with
COM with the specific ob- jectives of
(1) studying the existence of
pathologic changes in the CLE of
pa- tients with COM and (2)
comparing find- ings in patients with
COM with choles- teatoma vs those
without.
METHODS
Patients selected for the present study
carried a diagnosis of COM and were
followed at the outpatient clinic for COM.
We defined COM as chronic
inflammation of the middle ear and/or
mastoid associated with a permanent
perforation or retraction of the tympanic
mem- brane (TM) with or without
otorrhea. Choles-

(REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 134 (NO. 3), MAR 2008 WWW.ARCHOTO.COM
290

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