ORIGINAL ARTICLE DOI: 10.4274/jcrpe.

3585
J Clin Res Pediatr Endocrinol 2017;9(1):48-51

Association Between Endocrine Diseases and Serous Otitis

Media in Children
Murat Koçyiğit1, Taliye Çakabay1, Safiye G. Örtekin1, Teoman Akçay2, Güven Özkaya3, Selin Üstün Bezgin1, Melek Yıldız4,
Mustafa Kemal Adalı5
1Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Otolaryngology, İstanbul, Turkey
2Medical Park Gaziosmanpaşa Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
3Uludağ University Faculty of Medicine, Department of Biostatistics, Bursa, Turkey
4Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
5Bir Nefes Private Hospital, Clinic of Otolaryngology, Kırklareli, Turkey

What is already known on this topic?

Relationship between otitis media with effusion (OME) and endocrine diseases is not clear in pediatric population.

What this study adds?

Specific endocrine diseases such as metabolic syndrome, growth hormone deficiency, hypothyroidism, and idiopathic short stature may
accompany OME.

Abstract
Objective: Otitis media with effusion (OME) is a condition in which fluid is retained in the middle ear cavity. The association between
endocrine disorders and OME has not yet been determined. This study aimed to investigate the presence of OME in children diagnosed
with an endocrine disease and the relationship between these two conditions.
Methods: The study was conducted on 918 pediatric patients (440 boys, 478 girls; mean age: 8.40, range 3-15 years) and 158 healthy
controls (76 boys, 79 girls; mean age: 8.31, range 3-15 years). All children underwent an ear examination and a tympanometry performed
by an otorhinolaryngologist. Tympanometry results were used to diagnose OME.
Results: OME was detected in 205 (22.3%) of 918 patients and in 19 (12.0%) of 158 subjects in the control group. The difference in
frequency of OME between the two groups was statistically significant (p=0.003).
Conclusion: The results of the study reveal that there may be a tendency towards the occurrence of OME in pediatric endocrinology
patients.
Keywords: Otitis media with effusion, endocrine diseases, tympanometry

Introduction mucosa, immune deficiency, and allergy, among others (3).

The incidence of OME varies widely, being reported as 50%
Despite the development of antibiotics and advances in in British children (4), 8.7% in Japanese children (5), 8% in
surgical techniques, the frequency of otitis media with Nigerian children (6) with differences according to surveyed
effusion (OME) has been increasing (1). OME is a condition regions. OME is a leading cause of hearing impairment
in which fluid is retained in the middle ear cavity but without in children, and its early and proper management can
otalgia, fever, or other symptoms (2). This condition has prevent hearing and speech impairment, which can
been shown to be caused by complex reactions involving cause developmental delay in children (7). The incidence
the dysfunction of the Eustachian tubes, infection in the of endocrine disorders has also been increasing, but the

Address for Correspondence: Teoman Akçay MD, Conflict of interest: None declared
Medical Park Gaziosmanpaşa Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey Received: 15.07.2016
Phone: +90 212 404 15 00 E-mail: akteoman@yahoo.com Accepted: 01.09.2016
©Copyright 2017 by Turkish Pediatric Endocrinology and Diabetes Society
The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.

48
association between endocrine disorders and OME has not Results
yet been determined. Although there are many studies in
the literature about many diseases that are believed to be When the 918 patients and 158 healthy children who
associated with OME, there are no comprehensive studies participated in the study were compared in terms of their
showing a relationship between endocrine diseases and ages, a statistically significant difference was not detected
OME. This study aimed to investigate the presence of OME (p=0.086). While 88 (9.6%) of the 918 patients had
in children diagnosed with an endocrine disease and the adenoid vegetation, 830 patients (90.4%) did not. However,
relationship of these conditions with one another. when patients with adenoid vegetation were compared to
those who did not have adenoid vegetation for presence of
Methods OME, a statistically significant difference was not observed
(p=0.717). On the other hand, a comparison of OME
Our study was conducted on 918 pediatric patients (440 incidence in the two groups revealed a statistically significant
boys, 478 girls; mean age: 8.40, range 3-15 years) who difference (Table 1). Due to their small numbers, patients
presented to the pediatric endocrinology outpatient clinic with hypophyseal insufficiency, adrenal insufficiency,
and on 158 children with no otolaryngologic or endocrine hyperthyroidism, hyperinsulinemia, diabetes insipidus,
problems, constituting the healthy control group (76 boys, MEN-1 (multiple endocrine neoplasia), Graves’ disease,
79 girls; mean age: 8.31, range 3-15 years). All partipicants metabolic syndrome, macro-prolactinemia, hypoglycemia,
in the study group had at least one endocrine disease. vitamin D deficiency, hirsutism, congenital adrenal
Patients who had active otorhinolaryngological symptoms, hyperplasia, hypogonadism, and primary amenorrhea were
ear wax, cleft palate repair history in the past, and cases excluded from the statistical analysis (Table 2). OME ratios
with submucous cleft palate were excluded from the study. and the results of the comparisons in the remaining patients
Children diagnosed with an endocrine or metabolic disease, with the controls are shown in Table 3.
who did not have any otorhinolaryngologic symptoms
were compared to healthy children in the control group for
presence of OME. The study was conducted from April to Discussion
October 2015 due to the circulation of respiratory viruses
during winter months. Informed consent was obtained from OME is a leading cause of hearing impairment in children.
all individual participants included in the study or their Its early and proper management can avoid hearing and
parents. speech impairment and consequent developmental delay
in children (7). Among the factors thought to influence
A total of 918 patients in 24 different disease groups were
the effects of OME are age, sex, race, season of the year,
evaluated. Those diseases with numbers of patients under
hereditary factors, number of family members, smoking
18 were excluded from the statistical evaluation; their
status of parents, diseases experienced by children, and
OME rates were given only. The study was approved by
nursing methods. Factors reported to predispose to OME
the Institutional Review Board. Informed written consent
include upper respiratory tract infection, age, race, and
was obtained from the parents of the children studied after
attendance in day care centers, whereas factors that do
explanation of the research purpose.
not significantly influence OME include bronchitis, cystic
All children underwent a complete otolaryngologic fibrosis, socioeconomic status, smoking by parents, and
examination. A flexible nasopharyngoscope was used antibiotic abuse (9). The association between endocrine
to detect adenoid hypertrophy. Both ears were examined disorders and OME has not yet been investigated. In our
using an otoscope. Tympanometry was performed by an study, children diagnosed with an endocrine or metabolic
otolaryngologist using a MAICO m40, (Minneapolis, USA). disease and who did not have any otorhinolaryngologic
Tympanometric measurement results were classified
according to adjusted Jerger’s classification as types A, As, Table 1. Comparison between the patient and control
B, or C (8). Types A and As curves were accepted as no groups for otitis media with effusion
effusion in the middle ear, while types B and type C were Rates of OME p* value
considered as predictive of OME. Tympanometry results
were used to diagnose OME. Patient group (n=918) 205 (22.3%)
p=0.003
Statistical analysis were done by using Statistical Package Control group (n=158) 19 (12.0%)
for the Social Sciences 22.0 operating program (license no:
*: Chi-square test, p<0.05
10240642). Pearson chi-square test and Fisher-Freeman-
OME: otitis media with effusion
Halton test were used. Significance limit was set at p<0.05.

49
Koçyiğit
J Clin ResMPediatr
et al. Endocrinol Koçyiğit
J Clin Res Pediatr M et al.
Endocrinol
Endocrine Disease and Serous Otitis Media
2017;9(1):48-51 2017;9(1):48-51
Endocrine Disease and Serous Otitis Media

Table 2. The numbers (n) of patients and otitis media with effusion frequency in endocrine patients included in the
study
OME OME
Diseases n Diseases n
frequency frequency

Type 1 diabetes mellitus 181 16.6% Hyperinsulinemia 5 0.0%

GH deficiency 179 30.2% Diabetes insipidus 5 20.0%

Obesity 126 17.5% MEN-1 5 20.0%

Idiopathic short stature 135 25.9% Graves’ disease 5 20.0%

Precocious puberty 55 16.3% Macroprolactinemia 4 50.0%

Malnutrition 28 14.3% Hypoglycemia 3 0.0%

Turner syndrome 18 27.8% Vitamin D deficiency 3 100.0%

Metabolic syndrome 18 55.6% Hirsutismus 3 36.0%

Congenital adrenal
Pituitary insufficiency 10 60.0% 3 0.0%
hyperplasia

Adrenal insufficiency 8 12.5% Hypogonadism 2 0.0%

Hyperthyroidism 7 16.7% Primer amenorrhea 2 50.0%

Total 918 22.3%

OME: otitis media with effusion, GH: growth hormone, MEN-1: multiple endocrine neoplasia-1

Table 3. Rates of otitis media with effusion and OME incidence, a finding suggesting that there may be
comparisons between controls and otitis media effusion a tendency towards the occurrence of OME in pediatric
patients with endocrine diseases endocrine diseases.
Rates of OME p* value In the relevant literature, while there is very little information
Type 1 diabetes mellitus 16.6% p=0.235 about the importance of diabetes mellitus for ear diseases,
the focus is on the impact of diabetes mellitus on patients
GH deficiency 30.2% p<0.001
with external otitis, malignant external otitis, otitis media,
Obesity 17.5% p=0.195 sudden sensorineural hearing loss and slowly progressive
Idiopathic short stature 25.9% p=0.046 hearing loss (10).
Hypothyroidism 36.6% p<0.001 Kim et al (11) assessed 140 children aged 2-7 years who
Precocious puberty 16.3% p=0.665 underwent unilateral or bilateral ventilation tube insertion
for treatment of OME (experimental group) and 190 children
Malnutrition 14.3% p=0.756
with no history of OME who underwent operations for
Turner syndrome 27.8% p=0.076 conditions other than ear diseases during the same period
and reported that childhood obesity was significantly higher
Metabolic syndrome 55.6% p<0.001
in children with OME. This finding suggests that childhood
*: Chi-square test, p<0.05
OME: otitis media with effusion, GH: growth hormone
obesity could have an effect on the development of OME.
Kim et al (12) reported that pediatric obesity may have an
symptoms were compared to healthy children in the control effect on the development of OME, but pediatric overweight
group for presence of OME. was not reported to be associated with occurrence of OME.
In our study, a statistically significant difference was Middle ear problems are reported in rare genetic syndromes
observed between the patient group and the controls in that cause short stature such as achondroplasia and

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J Clin Res Pediatr Endocrinol Koçyiğit M et al.
2017;9(1):48-51 Endocrine Disease and Serous Otitis Media

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