Should adults with isolated serous otitis media be undergoing routine biopsies of the post-nasal space?

Abstract

Background Serous otitis media is a recognised presentation of Eustachian tube dysfunction secondary to post-nasal space pathology. Post-nasal space biopsies are commonly taken in patients with isolated serous otitis media, despite normal nasendoscopy findings, without robust evidence for doing so. This study examined cases of unilateral serous otitis media with effusion in adults. It is the largest known retrospective study to investigate whether post-nasal space biopsies are indicated in non-endemic regions. Methods A retrospective analysis was performed of 119 patients who underwent post-nasal space biopsy because of isolated serous otitis media, in a tertiary referral centre, from 2007 to 2017. Endoscopic examination and final histological report findings were reviewed. Results Of the 119 patients identified, 6 (5.0 per cent) were found to have abnormal histology. In all six cases, suspicious clinical findings had been noted on nasendoscopic examination prior to biopsy. Conclusion Suspicious findings pre-operatively predict sinister pathology. Biopsies are not recommended in cases of adult serous otitis media with normal nasendoscopy findings if no other risk factors exist. A UK-wide retrospective study or prospective study over the next 10 years will help provide the evidence necessary to support this guidance.

Outcomes of examination under anaesthesia of post-nasal space and grommet insertion in adults presenting with otitis media with effusion

“…Our results support the low yield of examination under anaesthesia of the post-nasal space in patients presenting solely with OME, in accordance with previous studies. 3,[5][6][7] Moreover, recent studies from endemic countries show that MRI offers significantly higher sensitivity than flexible nasoendoscopy in investigating the post-nasal space, and nonsignificantly higher sensitivity than endoscopic biopsy of the post-nasal space. 18 Previous case reports have highlighted that post-nasal space malignancy presenting with OME can nevertheless show a normal post-nasal space on flexible nasoendoscopy.…”

“…4 However, this recommendation has been questioned by other authors from non-endemic areas. 3,[5][6][7] Given this controversy, we conducted a systematic literature review to identify alternative investigative modalities for adult patients with OME that we could implement in a new management protocol.…”