Does auditory tube angle really affect childhood otitis media and size of the mastoid? Tulay Erden Habesoglu *, Mehmet Habesoglu, Seyla Bolukbasi, Barıs Naiboglu, Murat Eriman, Murat Karaman, Erol Egeli Department of Otolaryngology - Head and Neck Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey 1. Introduction Chronic otitis media (COM), which is usually associated with purulent otorrea and hearing loss, is an inflammatory disease of middle ear and mastoid. COM has been shown to be related to recurrent acute otitis media or chronic otitis media with effusion in childhood [1–3]. It is also known that AT plays an important role in maintaining middle ear physiology and functions, and that the AT of an infant is short and located horizontally compared with that of an adult [4,5]. Due to these anatomical features, infants and children are highly susceptible to otitis media with effusion (OME). With craniofacial growth and development, the auditory tube acquires the characteristics of the adult [6,7]. Consequently, there is a reduction of prevalence of otitis in adolescence [8]. Craniofacial growth, as well as anatomical variations in craniofacial anatomy, has been considered to be associated with middle ear disease [9,10]. Amongst anatomical craniofacial structures, mastoid and AT form a structural and functional unit; therefore, it is reasonable to expect that a correlation exists between various parts of this structural unit (AT and mastoid). So that, this correlation permits the compensation of one part for the other [11]. Although mastoid size and AT have been studied in detail [9,12– 14], the possible significance of the angle that the bony segment of the AT forms at the tympanic opening on its way to the nasopharyngeal orifice has not been well studied. Furthermore, there are only a few reports describing ATA in patients with COM. It is defined as the angle between a longitudinal line bisecting the transverse length of the external auditory canal and the long- itudinal axis of the AT [11]. The aim of this study was conducted to determine whether ATA has an effect on mastoid size and evolution of COM which is a sequela of childhood recurrent otitis media and otitis media with effusion. Also the relationship between the size of the mastoid and ATA and its possible importance in chronic ear diseases were studied. 2. Materials and methods Twenty-five patients with unilateral COM were included in the study. All of these patients had unilateral COM without choles- teatoma and athelectasia. The contralateral ears of the patients International Journal of Pediatric Otorhinolaryngology 73 (2009) 747–749 ARTICLE INFO Article history: Received 3 December 2008 Received in revised form 19 January 2009 Accepted 26 January 2009 Available online 26 February 2009 Keywords: Auditory tube angle Mastoid size Otitis ABSTRACT Objective: To assess the cross-sectional area of mastoid air cells and auditory tube angles (ATA), which were defined as the angles between the longitudinal line bisecting the transverse length of the external auditory canal and the longitudinal axis of the auditory tube (AT), both in healthy ears and diseased ears in patients with unilateral chronic otitis media (COM). Methods: 25 patients who had unilateral COM were included in the study. Assessment was performed using a quantitative digital image processing computer tomography (CT) program. Study design: Prospective study with institutional review board approval including adult patients who had otological symptoms since their childhood period. Results: Mastoid areas were greater on the healthy side than on the diseased side (p < 0.05). ATA were not significantly different among groups (p > 0.05). When we compared ATA with mastoid area in each group; there were no significant correlations in both healthy group and COM group (p > 0.05). Mastoid size in COM group was smaller than in the healthy group. Conclusion: We suggest that middle ear inflammations in childhood may affect mastoid size but, the anatomic relationships of the auditory tube, mastoid and middle ear that form a functional unit may not be significantly important in chronic ear disease. ß 2009 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +90 5325027010. E-mail address: tulayhabesoglu@yahoo.com (T.E. Habesoglu). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2009.01.018