[Otitis media with effusion: treatment by autoinflammation using a balloon]

Abstract

Resolution of negative middle ear pressure is important in treating otitis media with effusion (OME). We treated 34 children and 21 adults with OME by autoinflammation using a nose tube and balloon in the 16 months from June 2001 to September 2002. Of these, 7 children and 5 adults had been treated for 3 years or longer, and had had grommets inserted. In 49 ears of 27 early cases of children, 34 ears (69%) improved in tympanometric findings converting to type A from type B, C2 and C5, and 9 ears (18%) of type B converted to type C1. In 23 ears of 16 early cases of adults, 12 ears (52%) improved converting to type A from type B, C2, C5 and C1, and 3 ears (13%) to type C1 from type B. However, 4 ears of 4 children and 5 ears of 5 adults did not recover by autoinflammation. In 7 children with prolonged OME in whom grommets had been inserted, 5 recovered due to autoinflammation, whereas only one of 5 adults recovered. Of 6 patients who had not recovered, 2 were associated with asthma and nasal polyposis and eosinophils infiltrated into the middle ear effusion. In other 2 patients, even when the middle ear effusion disappeared by grommets insertion, they had still dysfunction of the Eustachian tubes confirmed by sonotubometric examination. It seems no beneficial effects of autoinflammation were maintained if patients had tubal dysfunction due to intensive inflammatory changes of the middle ear and tubal mucosa or other unknown origin. Two patients used the device irregularly and rarely. There is a theoretical risk associated with this maneuver of causing baroinjury and forcing infected nasopharyngeal secretions into the middle ear, but we found no complications.