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Introduction: To improve treatment outcomes for tubotympanic type chronic otitis media, it is crucial to identify and treat sino-nasal pathologies, as they can affect the treatment outcomes. Objective: the aim of this study was to find out the association of tubotympanic type chronic suppurative otitis media with sino-nasal pathologies. Materials and method: The current prospective observational study was carried out at the ENT department of Saidu Medical College / Saidu Group of Teaching Hospitals, Swat over a period of 6 months from November 2025 to April 2026 after taking approval from the ethical committee of the hospital. For sample collection consecutive on- probability method was used. Individuals of both genders and different age groups (10-60 years) diagnosed with tubotypanic type chronic suppurative otitis media form OPD and the inpatient department were included in this study. The sample size was determined using who calculator. Patients with chronic suppurative otitis media underwent otoscopic examinations to assess the tympanic membrane and ear discharge. Hearing loss was measured in decibels (dBs) and classified as normal (0-25 dB), mild (26-40 dB), moderate (41-55 dB), moderately severe (56-70 dB), or severe (71-90 dB). SPSS version 23 was used for data analysis. Quantitative data were presented as mean and standard deviation where’s as qualitative variables were presented as percentages frequencies. Pearson chi-square test was applied to find out the association of CSOM with sino nasal pathologies. A p value less than 0.05 was considered statistically significant. Results: In this study, a total of 88 individuals with CSOM were enrolled, out of which males were 52(59.1%) and females were 36(40.9%). The mean age of the study population was 26.4 ± 11.7 (range 10- 60 years) years. The majority of participants 70 (79.5%) had unilateral disease, with only 18(20.5%) having bilateral CSOM. The most prevalent sinonasal abnormality was DNS 42(47.7%) followed by Chronic Rhinosinusitis 35(39.8%). Association between clinical findings of CSOM and the absence or presence of sinonasal pathologies were evaluated by applying chi-square test. Individuals with Sino nasal disease were considerably more likely to suffer tympanic membrane perforation compared to individuals without Sino nasal disease (p=0.018). The kind of ear discharge had no meaningful association with the existence of Sino nasal illness. (p = 0.421). Patients with Sino nasal abnormalities were more likely to develop moderate to severe hearing loss than those without Sino nasal issue. (p=0.011).Conclusion: The present study concluded that sinonasal pathologies are most prevalent in individuals with tubotympanic chronic suppurative otitis media. These pathologies are significantly associated with the severity of hearing loss and tympanic membrane perforation.
Chronic suppurative otitis media (CSOM) is a kind of ear disease marked by a chronic infection of the middle ear in the absence of an intact tympanic membrane. This is a long-term inflammation of the middle ear & mastoid cavity. The distinctive presentation is chronic or persistent otorrhoea through a fractured tympanic membrane over 2 to 6 weeks.1 CSOM affects more than 300 million individuals globally, with 60% experiencing severe hearing loss. It is an constant inflammation of the middle ear cleft's mucoperiosteal lining.2 It is associated with a chronic tympanic membrane abnormality and ear discharge that lasts more than three months. The main causes of this disease include bacterial infection & Eustachian tube dysfunction. The Eustachian tube is critical in this condition, with malfunction identified in 70% of individuals following middle ear surgery. When the Eustachian tube fails, pressure equilibration in the middle ear is disrupted, resulting in abnormal middle ear aeration and the characteristic signs of chronic suppurative otitis media.3 Although viruses are the most prevalent cause of otitis media, bacteria frequently cause chronic suppurative otitis media in children. The etiology is typically polymicrobial. The most prevalent bacterium detected in this pathology is Staphylococcus aureus (MRSA). Others, including Proteus spp , Fusobacterium spp , Pseudomonas aeruginosa,., Klebsiella spp and Bacteroides spp can cause the illness. Aspergillus spp. and Candida spp. are less prevalent, but more commonly seen in immunocompromised people.4 Chronic suppurative otitis media is classified as tubo-tympanic/mucosal or attic-antral/squamosal, depending on the etiology of the disease.5 The nasal cavity, paranasal sinuses ,nose and middle ear cleft have similar physiologic roles, pseudostratified columnar epithelium, and a similar drainage system. Sinonasal disorders and chronic otitis media have many causes, including bacterial biofilms and infections. Bacterial biofilms and bacterial infection are two common disease development mechanisms regarding sinonasal disorders and chronic otitis media.6 By affecting the eustachian tube pressure, diseases of the nose and paranasal sinuses affect the middle ear cleft and vice versa; for example, deviated nasal septum, concha bullosa, paradoxical middle turbinate, and rhinosinusitis alter middle ear functioning.7 In 62% of individuals with chronic suppurative otitis media, there is a deviated nasal septum. In 5.1% of chronic otitis media patients, chronic rhinosinusitis is also present. Inferior turbinate hypertrophy occurs in approximately 17.6% of cases.8 A research in Pakistan revealed that 50% of individuals with nasal polyps had chronic suppurative otitis media. Failure in tympanoplasty surgeries and diminished mastoid aeration might occur if middle ear, nasopharyngeal, and Eustachian tube dysfunction are not addressed prior to otitis media therapy.9 To improve treatment outcomes for chronic otitis media, it's crucial to identify and treat sinonasal pathologies, as they can impact the treatment outcome. Therefore the current study was performed to determine the Association of tubotympanic type chronic suppurative otitis media with sinonasal pathologies.
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