A novel predictive marker for the viscosity of otitis media with effusion

https://doi.org/10.1016/j.ijporl.2015.10.043Get rights and content

Abstract

Objectives

To evaluate the significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the prediction of the viscosity of otitis media with effusion.

Methods

This retrospective study was performed on 81 patients who were admitted to the otolaryngology clinic.The patients were divided into two groups according to their effusion type, as serous or mucoid, which was defined intraoperatively after myringotomy. The NLR and PLR were calculated as a simple ratio between the absolute neutrophil/platelet and absolute lymphocyte counts.Tympanostomy tube insertion was performed for all cases.Under direct visualization, the effusion was aspirated and classified as serous or mucous.

Results

We postulated that an NLR value of less than 1.38 may show mucoid effusion and if the PLR value is less than 97.96, the effusion is mucoid.

Conclusions

We speculate that a useful predictor of viscosity for a middle ear effusion could prevent unnecessary surgeries and additional costs in the treatment of EMO. Additional studies are needed to confirm our results.

Introduction

Otitis media with effusion (OME) is one of the most common childhood conditions, affecting approximately 90% of children before school age [1]. OME is characterized by an accumulation of fluid in the middle ear, behind an intact tympanic membrane, in the absence of signs or symptoms of acute infection [2].

The exact mechanism for the pathogenesis of OME is not clearly understood. However, bacterial infection, Eustachian tube dysfunction, allergy and immunologic factors are reported as major causes in the literature [3]. Sinusitis and adenoid hypertrophy are also known to be involved in the disease process [4].

The fluid in otitis media with effusion is characterized by the presence of mucin glycoproteins, which are the macromolecules that are primarily responsible for the viscoelastic properties of middle ear fluid [5]. The factors affecting the viscosity have not been identified, even though some studies have discovered that the bacteria in serous fluid are more than in mucous [6].

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are defined as potential markers of inflammation, and they can routinely be measured in peripheral blood without additional cost [7], [8].

To the best of our knowledge, the NLR and PLR values in otitis media with effusion and their role in the viscosity of fluid in the middle ear have not been investigated. Considering this, our aim was to investigate the relationship between viscosity in otitis media with effusion and inflammation by considering NLR and PLR, which are measured routinely in complete blood count (CBC) tests without additional cost.

Section snippets

Materials and ethods

This retrospective study was performed on 81 patients who were admitted to the otolaryngology clinic. All of these patients underwent an operation for otitis media with effusion, between 2010 and 2015. Our study was approved by the local ethics committee and conducted in accordance with the ethical principles of the Declaration of Helsinki.

We reviewed the patients’ files for their clinical, tympanometric and laboratory data. The patients were preoperatively classified with otoscopic examination

Results

A total of 154 patients, 77 (50%) males and 77 (50%) females, were included in the current study. The demographic values were primarily compared. The serous group included 47 subjects (27 (57.4%) M/20 (42.6%) F), and the mucoid group included 34 (16 (47.1%) M/18(52.9%) F) subjects.

The control group included 73 (34(46.6%) M/39(53.4%) K) age- and sex-matched healthy subjects. There was no significant difference between the groups according to gender (p = 0.281). The mean age for the serous group

Discussion

OME is the most common cause of hearing loss in children, and if it is not treated properly, it may induce language and learning difficulties. Ventilation tube insertion is the most common pediatric surgical procedure in many industrialized countries [2]. The pathophysiologic mechanisms of persistent OME are not well introduced. Dysfunction of the Eustachian tube is an important factor, but there is increasing interest in the role of persistent bacterial infection and associated chronic

Conclusion

We speculate that a useful predictor of viscosity for a middle ear effusion could prevent unnecessary surgeries and additional costs in the treatment of EMO. Further prospective studies using a viscometer to directly measure the viscosity of the middle ear are needed to confirm the sensitivity and specificity of NLR and PLR values as a predictive marker.

Acknowledgements

The authors received no grants or other scientific support related to the preparation of this manuscript.

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