Kruk M. Diagnosis of chronic nonsuppurative otitis media with auditory tube dysfunction in patients with allergic rhinitis

Thesis is devoted to the problem of the efficiency of diagnosis of chronic nonsuppurative otitis media (NOT) in patients with seasonal and perennial allergic rhinitis (AR) through the improvement of comprehensive survey. A total of 188 people (376 ears) were examined in the periods of exacerbation and remission, including 56 with seasonal AR, 82 with perennial AR, and a healthy control group of 50 people. The survey of the patients and the control group was performed using tests SNOT-22 (Sinus-Nasal-Outcome Test-22), followed by otomicroscopy to evaluate the atelectasis of eardrum by M. Tos (1980), J. Sade (1979), and Ch. Bluestone (2005). Impedance tympanometry method was improved by the swallowing test, Toynbee test, and Valsalva test with the purpose to determine the equipressor and ventilation functions of auditory tube. Optical examination method of the pharyngeal orifice of auditory tube in dynamics with video recording by D. Poe (2011) was supplemented by Toynbee and Valsalva tests (Optical ear salpingoscopy dynamics). The auditory tube dysfunction determined in the acute phase of AR, was restored after the treatment in most of the cases (70.54%). In patients with persistent AR CT EVF full recovery occurred much less frequently, only in 20.73% cases. The causes were allergic endosalpingitis tube dysfunction, flooding pharyngeal mucous eye discharge, and the reduced function of the lower valve ET. Tubotympanitis with different degrees of atelectasis and bent parts of vistula eardrum was found in 67.85% of patients with AR in an exacerbation phase (atelectatic otitis 1-2 in). Also, 5.36% of the patients were diagnosed with the chronic fibro-adhesive otitis media (total atelectasis otitis media of 2-3 degree), which is significantly higher as compared to the healthy control group (p <0.001). The chronic tubotympanitis (atelectasis otitis media of 1-2 degree) was found in 67.07% of patients with persistent AR in acute phase; which is equivalent to 18.29% as normalized to the number of ears (30 ears total) and statistically significant as compared to the control group. Fibrous adhesive otitis media (total atelectasis otitis of 2-3 degree) was determined in 25.61% of patients, which is statistically significant as compared to the group of patients with seasonal AR. The causes of NOT were defined as follows: AR lasting since childhood with the dysfunction of ICT and auditory tube, low level of the middle ear pneumatization. Otoscopic changes often develop slowly with the minimum symptoms. Therefore, computed tomography with the determination of pneumatization volume of the middle ear structures allows to evaluate the prognostic development of NOT and to assess the duration of this process. Timely diagnostics of allergic process and functional status of the auditory tube followed by the early treatment of AR and tubar dysfunction is necessary for the prevention of NOT (atelectatic, fibro-adhesive). The assessment of the auditory tube functional state requires a comprehensive examination that includes otomicroscopy with the evaluation of stretched and non-stretched parts of the tympanic membrane, impedance tympanometry in dynamics, tone audiometry, and optical examination of the nasal cavity and nasopharynx, complemented by the functional assessment of the pharyngeal valve of auditory tube by the optical salpingoscopy.