Middle ear fluid characteristics in pediatric otitis media with effusion

Abstract

ObjectivePersistent otitis media with effusion is caused by poor clearance of middle ear fluid usually following an episode of acute otitis media. This fluid is thought to be viscous and poorly transportable by cilia. Because a subset of children require multiple myringotomy and tube placements for recurrent disease, we hypothesized that children requiring repeated procedures would have effusion fluid that was more viscous and less transportable than those having their first procedure. DesignProspective clinical study. SettingTertiary care center. Patients and interventionsMiddle ear secretions were collected at the time of myringotomy and tube insertion in 36 children accrued sequentially. Twenty-six of these children were having their first procedure and 10 had previously undergone myringotomy and tube placement. Main outcome measuresThe secretions were evaluated for in vitro mucociliary transportability, and dynamic rheology in a magnetic microrheometer. ResultsChildren with the need for repeated procedures had effusions with lower mucociliary transportability, and overall higher mean measures of surface mechanical impedance/frictional adhesion, but these did not reach statistical significance. Mucopurulent effusions had significantly greater transportability than both the mucoid and serous effusions in both groups. ConclusionsPersistent or recurrent otitis media with effusion is associated with poorly transportable middle ear fluid, which may have higher frictional adhesion. The best mucociliary transportability was measured in mucopurulent effusions.