Clinical

Monitoring, aggressive treatment key for otitis media in transplant candidates

Last Updated: 2009-10-06 17:05:29 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Prompt diagnosis and aggressive treatment are important to effectively manage chronic otitis media in organ transplant candidates, according to study findings presented this week at the American Academy of Otolaryngology -- Head and Neck Surgery Foundation Annual Meeting & OTO EXPO in San Diego, California.

Moreover, outcomes are improved when the patient is treated surgically rather than with antibiotic therapy or observation alone.

"Otolaryngologists or general physicians can have difficulty making the diagnosis of otitis media when the transplant patient does not complain of otological symptoms," lead researcher Dr. Myeong Sang Yu, from the University of Ulsan College of Medicine, Seoul, Korea, told Reuters Health.

"Furthermore," she said, "even though surgery is indicated," transplant candidates on waiting lists for organs "are anxious over the possibility of losing the suitable donor while having sinus surgery."

For these reasons, she said, "the prevention or effective treatment of chronic otitis media...may be a significant determinant in the success of organ transplantation."

At the Asian Medical Center in Seoul, South Korea, 65 of 3278 transplant recipients (2%) had pretransplant chronic otitis media, including 31 who eventually received liver transplants, 28 who had renal transplants, and 6 who received heart transplants. The most common symptom was otorrhea, followed by hearing disturbance, otalgia, and tinnitus. Bacterial growth was verified in 17 of 40 isolates.

The problem was managed with surgery in 9 patients, antibiotics in 26, and observation in 30. After transplantation, the surgically treated patients had an exacerbation rate of 11.1%, significantly lower than the 26.9% and 26.7% seen in the antibiotic and observation groups, respectively (p < 0.05).

Further research, Dr. Yu said, is needed to understand the mechanisms of otitis media exacerbation after transplantation and the effect of immunosuppression.