CONOTRUNCAL CARDIAC ANOMALIES AND OTITIS-MEDIA

Background: The neural crest influences the differentiation of the bra nchial arches, including the precursor tissue of the cardiac outflow t ract and the eustachian tubes. Abnormal eustachian tubes are associate d with otitis media. We hypothesized a relationship between conotrunca l anomalies and eustachian tube anomalies. Methods: We sun-eyed 115 no nsyndromic patients, aged 5 to 20 years, attending a state-run pediatr ic cardiology clinic. The cardiac anomalies were conotruncal (transpos ition of the great arteries, tetralogy of Fallot, or aortic stenosis) or nonconotruncal (atrial septal defect, tricuspid atresia, atrioventr icular canal). Tympanic membrane photographs were categorized independ ently by two physicians as to normal, abnormal (scarred or other indic ation of otitis proneness), or indeterminate. Results: For the 37 pati ents who had both ears categorized as normal or abnormal by both physi cians, 20 of the 26 with a conotruncal anomaly had evidence of otitis media. In contrast, only 4 of 11 with nonconotruncal cardiac anomaly h ad evidence of otitis (p < 0.03; relative risk [conotruncal vs noncono truncal], 5.83; 95% confidence interval, 1.26 to 26.95). Conclusion: T he concept is supported that a neural crest determined branchial field defect influences the development of the cardiac outflow tract and th e eustachian tubes. Children with congenital cardiac conotruncal anoma lies are otitis media prone.