There have been patients with secretory otitis media (SOM) who had frequent ear infections or dark red discharge while receiving middle ear tube treatment and had poor prognosis. In some of these patients cholesterol crystals were detected microscopically in the middle ear fluid or ear discharge.
Microscopic detection of cholesterol crystals in the middle ear fluid is thought helpful for determining prognosis.
There have been no reports on frequency of cholesterol crystals found in middle ear fluid in SOM patients or when cholesterol crystals appeared, therefore the middle ear fluid was examined.
The findings are summarized as follows: 1. In the fluid of 124 of 172 ears of 86 children with SOM, cholesterol crystals were detected (cholesterol positive) in 98 ears (79%). The children ranged in age from 2.7 to 13.8 years. Of 86 children 43 were boys (50%). One of the reasons for the high percentage was that all of our patients were first seen at another clinic and referred to us due to poor clinical course of the disease.
2. Cholesterol crystals were found in 81.7% of glue middle ear fluid and in 81.8% of chocolatecolored middle ear fluid. The development of pneumatization of the temporal bone was small in all ears.
3. Of the ears treated with middle ear tubes, those in the cholesterol positive group had more frequent infections and dark red discharge than those in the cholesterol negative group or in the unexamined ones. 35 ears (36.8%) of the cholesterol positive group were accompanied with infections, although 3 ears (25.0%) in the negative group and 8 ears (24.2%) in the unexamined group also were accompanied with infections.
Dark red discharge was found in 31 (32.6%), 5 (20.8%) and 3 (9.0%) respectively.
4. In the patients treated with middle ear tubes for more than 2 years, 17 of 32 (53%), 2 of 3 (67%) and 5 of 8 (63%) respectively were completely cured.
5. Our studies demonstrated that the presence of cholesterol crystal in middle ear fluid is important when we considered the natural history of SOM, especially in severe cases. We strongly recommend microscopic examination of middle ear fluid for SOM.
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