On the issue of preoperative preparation of patients with chronic suppurative otitis media

Abstract

Introduction. In the otosurgeon practice, there are often cases of exacerbation of chronic suppurative otitis media (CSOM) refractory to conservative therapy. The direct irritant effect of gastric contents due to the gastroesophageal reflux disease (GERD) often leads to alteration of the middle ear mucosa and persistence of the inflammation process.Aim. To substantiate the significance of GERD therapy in the treatment of CSOM exacerbation refractory to the standard conservative therapy protocols.Materials and methods. The study group included 42 patients aged 19 to 67 years (mean age 47.6 years), 13 men and 29 women, who received treatment and daily observations of the attending otorhinolaryngologist. Of these, 31 patients were users of oral nicotine products (chewing gum, smoking, tobacco heating systems). The conservative treatment of CSOM was carried out in accordance with the medical care standards and clinical guidelines as in force on the time of the treatment process. The conservative treatment of GERD was carried out in accordance with the clinical guidelines approved by the Russian Gastroenterological Association.Results and discussion. 25 patients were diagnosed with isolated incompetence of the gastric cardia, 13 — with incompetence of the gastric cardia accompanied by reflux esophagitis, 4 — with hiatal hernia. The efficacy of anti-reflux therapy for chronic otitis media exacerbation was assessed on Day 10 after start of the therapy. Due to the gastroenterological therapy, the “dry” ear status could be achieved in 34 patients, which made it possible to offer them reconstructive intervention in the future. 5 patients achieved the CSOM remission by the end of the first month of anti-reflux therapy. 3 patients failed to achieve the state of CSOM remissionConclusions. The high efficacy of anti-reflux therapy for the management of CHSO exacerbation refractory to the standard conservative therapy regimens at the level of 81% allows us to recommend further research to prove the causal relationship between GERD and ineffectiveness of treatment of ear pathology.