Pneumonia shows strong connection to chronic otitis media

Study conducted by the Hallym University College of Medicine, seeks to determine the connection between chronic otitis media and patients diagnosed with pneumonia.

Chronic otitis media, right middle ear mucosa transformed into epidermis. Photo: Shutterstock

Data from a study, published in the International Journal of Infectious Diseases, with more than 100,000 patients, determined in preliminary results that people who have a diagnosis of pneumoniaare significantly more likely to develop chronic otitis media.

The researchers identified 23,436 adults with chronic otitis media and 93,744 controls aged 40 or older from a Korean health insurance database from the years 2002 to 2015. Dr. Sung Gyun Kim of the Hallym University College of Medicinein Dongtan, Korea, and colleagues say that until now it had not been evaluated whether there was a possible relationship between pneumonia and chronic otitis media,

“Recently, diseases of the middle ear, including chronic otitis mediahave been recognized as airway diseases beyond the pathophysiological concepts of ventilatory dysfunction, according to which recurrent infection occurs from anatomically adjacent structures such as the middle ear, mastoid cavity and Eustachian tube,” Dr. Sung Gyun Kim added.

The overall incidence of pneumonia in the study population was significantly higher in the group with chronic otitis media compared to controls (9.3% vs. 7.2%, p < 0.001).

In terms of probability, the pneumonia was significantly higher in the group with chronic otitis media compared to controls, and history of pneumonia increased the chances of chronic otitis mediaregardless of gender and for all ages.

The pneumonia was defined as a diagnosis of pneumonia based on codes from the latest edition of the International Classification of Diseases (ICD-10) in a patient who underwent chest radiography or chest computed tomography. The chronic otitis media was defined as a diagnosis based on ICD-10 codes on at least two occasions, with one of the following disorders:

  • Chronic otitis media serous

  • Chronic otitis media mucoid.

  • Other chronic non-suppurative otitis media.

  • Non-suppurative otitis media, unspecified.

  • Chronic suppurative tubotympanic otitis media.

  • Atticoantral chronic suppurative otitis media.

  • Other chronic suppurative otitis media.

  • Suppurative otitis media, unspecified.

Age groups were divided into five-year intervals, and patients were classified into income groups and rural or urban residence.

In another sensitivity analysis, individuals who had been diagnosed pneumonia five or more times before the index date had a significantly higher odds ratio for the chronic otitis media compared to those with fewer than five diagnoses of pneumonia (adjusted odds ratio: 1.34; p<0.001).

The dysbiosis of the microbiome could explain part of the connection between the pneumonia and the chronic otitis media, the researchers wrote in their analysis. Pathogens in the lungs can cause changes in microbiome dynamics, as can antibiotic use, they noted. In addition, “mucosal plugging in the airways caused by pneumonia induces hypoxic states and leads to the expression of inflammatory markers in the Eustachian tube and middle ear mucosa,” they added.

The study findings were limited by several factors, including retrospective design and lack of data on microbiological cultures for antibiotic susceptibility, radiological findings on severity of pneumonialung function test results and hearing thresholds, the researchers noted.

Other limitations were the exclusion of the frequency of upper respiratory tract infections and the use of antibiotics due to lack of data, they commented.

However, the results show an association between the diagnoses of pneumonia and the increased incidence of chronic otitis mediaindicating a novel perspective that “lower respiratory tract infection may impair Eustachian tube and middle ear function to subsequently cause chronic otitis media“, they concluded.

It should be noted that this study did not receive any external funding. The researchers stated that they had no relevant relationships or financial support.

Source consulted here