Association Between Middle Ear Cholesteatoma and Chronic Rhinosinusitis

Abstract

IMPORTANCE Chronic rhinosinusitis (CRS) can cause an obstruction of the tubal orifice and thereby compromise ventilation of the middle ear. The resulting negative pressure in the middle ear may, in turn, lead to the formation of an eardrum retraction pocket and subsequent acquired cholesteatoma. This study hypothesizes that CRS may increase the risk of cholesteatoma. OBJECTIVE To evaluate the risk of cholesteatoma in patients with CRS. DESIGN, SETTING, AND PARTICIPANTS This study used a nationwide, population-based claims database to test the hypothesis that CRS may increase the risk of cholesteatoma. The Longitudinal Health Insurance Database of Taiwan was used to compile data from (1) 12 670 patients with newly diagnosed CRS between January 1, 1997, and December 31, 2002, and (2) a comparison cohort of 63 350 matched individuals without CRS, resulting in a CRS vs control ratio of 1:5. Data analysis was performed from June 1 to October 27, 2015. Each patient was followed up for 8 years to identify those in whom cholesteatoma subsequently developed. The Kaplan-Meier method was used to determine the cholesteatoma-free survival rate, and the log-rank test was used to compare survival curves. Cox proportional hazards regression models were used to compute the 8-year hazard ratios (HRs). MAIN OUTCOMES AND MEASURES Diagnosis of cholesteatoma. RESULTS Among the 76 020 patients enrolled in this study, 35 220 (46.3%) were female; mean (SD) age was 27.57 (22.03) years. A total of 209 patients developed cholesteatoma, 66 (101 084 person-years) individuals from the CRS cohort and 143 (506 540 person-years) from the comparison cohort were diagnosed with cholesteatoma during the 8-year follow-up period. The incidence of cholesteatoma per 1000 person-years was more than twice as high among patients with CRS (0.65; 95% CI, 0.50-0.81 person-years) than among those without CRS (0.28; 95% CI, 0.24-0.33). The absolute difference in the incidence density between CRS and non-CRS group was 0.37 (95% CI, 0.21-0.53) per 1000 patient-years. After adjusting for potential confounders, patients with CRS had a 69% increased risk of cholesteatoma within 8 years, compared with those without CRS (HR, 1.69; 95% CI, 1.23-2.32). Patients with CRS presented a significantly lower 8-year cholesteatoma-free survival rate than did those in the comparison group. The absolute difference in the 8-year cholesteatoma-free survival rate between the CRS and non-CRS groups was 0.0029 (95% CI, 0.0016-0.0043). CONCLUSIONS AND RELEVANCE This is the first large-scale study, to date, to demonstrate a prospective link between CRS and the subsequent development of cholesteatoma within a follow-up period of 8 years. The purpose of the study was to draw attention to the possibility of development of cholesteatoma among patients with CRS. Because that possibility exists, clinicians should keep this association in mind as well as the importance of a thorough head and neck examination.

Chronic rhinosinusitis could increase the risk of cholesteatoma of middle ear

“…In support of this hypothesis, previous several studies demonstrated that the dysfunction of the Eustachian tube was correlated with increased sinonasal symptoms and, it was common in patients with CRS who need endoscopic sinus surgery, and the symptoms resolved after the surgery 8,9 . Moreover, consistent with our study, one cohort study described a significantly higher subsequent development of cholesteatoma in CRS patients during an 8‐year follow‐up period than in controls 10 …”

Endotyping of Cholesteatoma: Which Molecular Biomarkers? A Systematic Review

“…Recent basic science research has led to significant advances in understanding the pathophysiological processes of disease. These processes define the endotype of a disease opening the way for the development of new diagnostic tools and innovative targeted treatments, especially in the rhinologic fields [ 33 , 34 , 35 , 36 , 37 , 38 ]. As has already happened for asthma and CRSwNP, and for many other autoimmune and oncological pathologies, the study of molecular biomarkers might help to develop new potential therapeutic target, and to improve an early diagnosis and a more accurate prognosis.…”

Glue Ear in Children with Cleft Lip and Palate: An Update

“…The clinical significance of OME is often overlooked and very few studies have explored this condition in depth, despite the fact that it is commonly associated with CLP. The author summarizes and updates his previous work with the article partly borrowing from the author's earlier publications [4,[9][10][11][12][13][14][15][16][17][18][19][20][21]. This paper presents a review of the pathogenesis, clinical manifestations, and diagnoses of OME in children with CLP as well as the controversies surrounding treatment.…”