The vestibular system is not immune to chronic otitis media
Reviewed by Victor Osei-Lah

It is well recognised that chronic otitis media (COM) is a risk factor for sensorineural hearing loss. Studies on the effect of COM on vestibular function have been beset by design biases. The authors designed a case control study to investigate the association between COM and vestibular symptoms, postural balance problems, and abnormalities in vestibular function tests in adults. They identified patients with COM by the presence of chronic infection or inflammation of the middle ear cleft, and perforation of tympanic membrane. A total of 126 consecutive patients with COM and 52 healthy volunteers serving as control were recruited. All subjects were assessed for vestibular symptoms (vertigo, dizziness, postural instability and vestibulo-visual), clinical vestibular examination (gait and stance, eye movements, head impulse and head shaking, cerebellar tests and positional tests). The two objective vestibular function tests were listed as static posturography and video head impulse test (vHIT). COM was divided into three groups: a) Chronic tympanic membrane perforation – CPTM – 60 patients; b) Chronic suppurative OM – CSOM – 27 patients; and c) CSOM with cholesteatoma – 39 patients. Unsurprisingly, patients in groups b and c had significantly worse hearing loss. The patient group as a whole reported significantly higher prevalence of vestibular symptoms than controls (58.4% vs. 2.0%: p <0.001) with the CSOM and cholesteatoma patients reporting more symptoms than those with CPTM. Onset or worsening of otorrhoea was reported as the main trigger for the onset of vestibular symptoms. Interestingly, the presence of tinnitus was associated with a two-fold increase in vestibular complaints. In 63% of patients, there was a positive correlation between COM and the stepping tests especially in those with vestibular symptoms. Postural instability was worse in the COM group compared with controls. Although vHIT was abnormal in nine patients, statistically, there were no differences in the VOR gain and symmetry between the patients and controls. The authors concluded that vestibular symptoms and poor postural control are common in patients with CSOM especially in the presence of active infection and cholesteatoma. Limitations on objective vestibular tests were addressed.

Evaluation of vestibular symptoms and postural balance control in patients with chronic otitis media.
Monsanto RdC, Kasemodel ALP, Tomaz A, et al.
JOURNAL OF VESTIBULAR RESEARCH
2020;30(1):35-45.