Middle Ear Effusion in Intensive Care Unit Patients at Al-Sadder Teaching Hospital in Al-Najaf City-Iraq (A Prospective Randomized Comparative Clinical Study)

Abstract

Background: Middle ear effusion (MEE) is one of the commonest chronic otological conditions in childhood but has a lower incidence in normal adult. By definition it is an accumulation of non-purulent fluid in the middle ear. It is an inflammatory effusion behind an intact tympanic membrane that is not associated with acute otological symptoms or systemic signs. Aim: To explore factors related to the occurrence of MEE in the intensive care unit (ICU) patients with prolonged oral endotracheal intubation in Al-Najaf city/Iraq. Methods: Forty patients (80 ears) with a prolonged endotracheal intubation (> 5 days) in the ICU were studied. Information of the age, gender, level of consciousness, duration of endotracheal intubation and placement of nasogastric tube were retrospectively collected from history and patient`s data. All patients were subjected to otoscopic examination, tympanometry studies and acoustic reflectometry for evidences of MEE. Results: Out of the 80 ears examined, 46 ears had MEE (57.5%), 22 ears were normal (27.5%), and 12 ears (15%) had negative pressure in the middle ear by tympanometry. Patients who were intubated for more than 11 days and those with conscious disturbance had a significantly high incidence of MEE. No episodes of acute otitis media or systemic infection were encountered. Conclusion: Prolonged endotracheal intubation (more than 11 days), age advancing and conscious disturbance contribute significantly to the occurrence of MEE in adult ICU patients. Recommendation: Middle ear pathology like MEE in the ICU patients with prolonged intubation should not be underestimated.