Key Points:
Keywords: Chronic otitis media; Cholesteatoma; Paranasal sinus radiology; Pneumatization
Background
Chronic otitis media (COM) is a disease characterized by the recurrent and persistent inflammation of the mastoid cavity, middle ear, and tympanic membrane 1. While the incidence of the disease is below 1% in the USA, the rates rise to 4% in developing countries, leading to significant morbidity and mortality2. Even though the etiology and pathophysiology of the disease are not completely revealed; low socioeconomic status, inadequate nutrition, passive smoking, insufficient mastoid pneumatization , and sinonasal diseases have been found pertinent to the progression of the disease 1,3.
The middle ear, mastoid cells, and paranasal sinuses are the largest air-filled cells with close anatomic localization in the skull and have similar embryologic characteristics 4. Both the paranasal sinuses and the mastoid cells are formed by pneumatization of the related bones, and their surfaces are lined with the upper respiratory tract epithelium, which is originated from endoderm. The development of mastoid cells, maxillary and frontal sinuses start in the embryological period and continue until puberty 4,5, while the pneumatization of the sphenoid sinus starts approximately in the 1st year of life and continue until the end of the 3rd decade 5,6. Due to the similar developmental pattern, close anatomic localization, and mucosal continuity of the mastoid cells and paranasal sinuses, an interplay of these structures at the development stage can be expected.
The association between mastoid pneumatization and COM has been long investigated, and the relationship between chronic inflammatory middle ear disease and poor mastoid pneumatization has been shown in several studies 7,8. Some studies show that sinonasal disease increases the risk of middle ear disease 3,9,10. However, to the best of our knowledge, only one radiologic study investigated the interrelation between the measurements of the paranasal sinuses and mastoid pneumatization in patients with COM and suggested a hypothesis that chronic rhinosinusitis during childhood may play a role in the development of cholesteatoma 11.
Material and Methods