JOURNAL READING

OTITIS MEDIAS WITH EFFUSION: ASSOCIATION WITH THE EUSTACHIAN

TUBE DYSFUNCTION AND ADENOIDITIS.
THE CASE OF THE CENTRAL HOSPITAL OF MAPUTO
PRESENTED BY:
RIZKI WIDYA NUR
RIZKY HADMA SUBARKAH
FK UNISSULA

Kepaniteraan Klinik Ilmu Penyakit Telinga Hidung

dan Tenggorokan
RSUD Kota Semarang

THE AIM OF THE RESEARCH

to
describe
the
association
of
eustachian
tube
dysfunction
and
adenoiditis with OME in the patients
that attend ENT departments in the
Hospital Central of Maputo, as well as
to
describe
their
clinical
and
epidemiological profiles.

VARIABLES

Dependent : Otitis medias with

effusion
Independent :

Eustachian tube dysfunction

Adenoiditis

PATIENTS AND METHODS

Place : Central Hospital of Maputo, the capital of Mozambique

Periode : 4.157 clinical files

December of 1998

Data : Age, sex, most common medical conditions, the

presence or not of tonsillitis, adenoiditis, recurrent otitis media,
history of rhinitis, physical and functional condition of the
tympanic membrane

Methods : Cross-sectional study. Processed and analyzed

using the SPSS 8.0 and GLIM programs. Bivariate analysis was
evaluated using the chi-squared test of independence.

during January

of 1995

RESULTS

RESULTS

RESULTS

RESULTS

RESULTS

RESULTS

23.3% of patients who visited the ENT

service of Maputo with otitis media were
children under the age of 3
the majority of the cases of otitis media with
effusion were observed in children aged
between 3 and 7 years (49.2%)
Otitis media with effusion is strongly
associated with a history of adenoiditis
and/or Eustachian tube dysfunction in boys
under the age of 7, (OR=9.53), and in older
patients (OR=12.26)

DISCUSSION

Otitis media with effusion (OME) is the inflammation of the

middle ear, characterized by the presence of liquid or
effusion behind an intact tympanic membrane, without
acute symptoms.

Hypertrophy of the adenoids and Eustachian tube

dysfunction are often considered to be causal factors of
this pathology. Furthermore, OME produces a complex,
multifactorial process, which is why the pneumatization of
the mastoids and the variation in the gaseous diffusion in
circulation have an important role in the negative pressure
phenomenon in the affected middle-ear

DISCUSSION : SEX

Various epidemiological studies of otitis

media show that, just as with most infections
in babies and infants, the incidence of otitis
media is usually greater in males than in
females. It is the same with complications, as
was demonstrated in the study conducted in
Boston, in which chronic forms were more
common in the male sex characterization
of the physiopathological development

DISCUSSION : AGE

the proportion of cases of otitis media with effusion

could be underestimated owing to the fact that it is
frequently asymptomatic in the initial phase of the
disease.
This can contribute to the parents of children under
the age of 3 not identifying the problem until they
reach school age or when the disease is at an
advanced stage
Children, they do not have the specific antibodies
required. This can be one of the reasons why children
are more susceptible to suffering from otitis.

DISCUSSION : EUSTACHIAN TUBE DYSFUNCTION

It is known that the etiology of otitis media is

multifactorial and other factors such as
infection, the functional state of the
Eustachian tube, the immunological state,
allergy,
and
environmental
and
socioeconomic factors can all be involved.
Of these factors, the functional state of the
Eustachian tube stands out given its function
of maintaining the ventilation in the middle
ear and the mastoids; a fundamental
condition for optimal hearing.

EUSTACHIAN TUBE DYSFUNCTION

The hypothesis that Eustachian tube dysfunction is the

origin of serous otitis media or otitis with effusion was first
posited by Politzer more than 100 years ago

Tube dysfunction can be caused by two factors:

obstruction and alteration of the permeability. The
obstruction can result from mechanical barriers, from
functional causes, or mixed situations in which the two
mechanisms are combined. The obstruction caused
mechanically can result from structural anomalies, extrinsic
factors from peritubic compression due to adenoids,
tumors, or to an increase in extramural pressure in supine
decubitus

hypertrophy of the adenoids reduces the

ventilation of the nasopharynx, increases the
accumulation of secretions and can be the
focus of infection for the middle ear
internal obstruction of the Eustachian tube
reduction in the ventilation of the middle ear
Functional obstruction has been observed in
various nasopharyngeal inflammatory and
allergic diseases, with a drop in air pressure
in the eardrum together with the
obstruction of the tube causes the
accumulation of liquid

the immaturity of the immune system, already only

slightly effective, increases the risk posed by
anatomical factors, as the Eustachian tube is short
and more horizontal This can facilitate the
propagation of infections localized in the nasopharynx
of the middle ear.
This immunological immaturity, together with the
anatomical and functional immaturity of an infants
ear, could constitute factors that strengthen each
other and which would explain the seriousness of
some otitis media symptoms that develop to a
chronic state, even when correctly treated

CONCLUSION

The proportion of cases of otitis media

with effusion noticeably increases in
patients
with
Eustachian
tube
dysfunction.
Another factor that can be significant in
patients under the age of 7 is the
presence of adenoiditis.

 THANK YOU