Computed Tomography Is Required to Rule Out Nasopharyngeal Pathology in Adults with Serous Otitis Media. (23rd August 2013)

• Record Type: Journal Article
• Authors: Toman, Julia; Perry, Katherine; Strome, Scott E.; Eisenman, David J.; Hertzano, Ronna
• Is Part Of: Otolaryngology--head and neck surgery. Volume 149(2013)Supplement 2
• Page Start: P149
• Page End: P149
• Publication Date: 2013-08-23
• Subjects: Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813496044a23
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: 1) Review the current diagnostic evaluation of adults with new‐onset serous otitis media (SOM). 2) Compare the ability of fiberoptic nasal endoscopy (FNE), random nasopharyngeal biopsies, and computed tomography (CT) to detect nasopharyngeal pathology. 3) Clarify the role of imaging and random nasopharyngeal biopsies in the evaluation of SOM. Methods: This is a retrospective chart review of adults who presented with SOM to a tertiary care center from 2006 to 2012 and who underwent pressure equalization tube (PET) placement and nasopharyngeal biopsies. Subjects were identified though a search of operative and pathology records. Charts were reviewed for physical exam findings, including FNE, intraoperative exam, biopsy results, and imaging. FNE findings were classified as suspicious or non‐suspicious. Results: Thirty‐four subjects were identified who met the inclusion criteria. Twenty‐nine subjects had non‐suspicious findings on FNE while five had suspicious findings. Two of the twenty‐nine subjects with non‐suspicious findings, and two of the five subjects with suspicious findings proved to have significant nasopharyngeal pathology, including nasopharyngeal carcinoma and sinonasal polyp. Importantly, CT imaging had a negative predictive value of 100% for the presence of nasopharyngeal pathology. Conclusions: All adults presenting with persistent new‐onset SOM should undergo CT scanning to rule out nasopharyngeal pathology. The decision to perform a biopsy should be based on CT findings. If imaging is normal, random nasopharyngeal biopsies are not required and PET placement may be performed in the office. Normal FNE does not exclude nasopharyngeal pathology.