ADULT-ONSET OTITIS-MEDIA WITH EFFUSION

Objective: To document the prevalence of adult-onset otitis media with effusion (OME), and to determine its causes, diagnostic approach, and therapeutic management. Design: A prospective study of 167 consecutiv e patients with adult-onset OME. Endoscopic examination of intranasal and nasopharyngeal structures with special attention to the eustachian tube orifices was performed in all patients. In 65 patients computed tomography of the skull base, neck, and paranasal sinuses was also per formed. Results: Paranasal sinus disease, predominantly of the ethmoid system, was found to be the dominant causal factor in 110 patients (6 6%). Smoking-induced nasopharyngeal lymphoid hyperplasia and adult-ons et adenoidal hypertrophy, two entities herein described, were the caus e of OME in 15 patients (19%). Various other causes were found in 31 p atients. Head and neck tumors, mainly nasopharyngeal carcinomas, were found in only eight patients (4.8%). The cause of adult-onset OME coul d not be determined in three patients (1.8%). Conclusions: Contrary to common belief, adult-onset OME is not an uncommon disease. Nasendosco py is the mainstay of diagnostic evaluation in most patients. Computed tomography is also an important tool in most selected cases. Appropri ate treatment of sinusitis resulted in resolution of OME in most patie nts. Sinusitis is the most common causal factor of adult-onset OME, bu t nasopharyngeal and parapharyngeal space-occupying lesions should be ruled out in all cases.