Middle Ear Effusion in Mechanically Ventilated Patients: Effects of the Nasogastric Tube

Abstract

BACKGROUND: Middle ear effusion (MEE) is rare among adults, but has a higher incidence among ICU patients. The aim of this study was to analyze the effect of nasogastric tube (NGT) on MEE and to assess other predisposing factors. METHODS: Prospective observational study, carrying out an otoscopic examination and tympanometry in 100 mechanically ventilated patients. Immittance testing was carried out within 24 hours of ICU admission and every 72 hours until ICU discharge. In a case of persisting pathologic curve at the moment of discharge from ICU, there was a follow-up examination every 3 days until middle ear function was restored. In addition to descriptive variables, we recorded placement (left or right nostril) and diameter (12, 16, or 18 French) of the NGT. A Cox regression analysis was performed, adjusted for the days since ICU admission. RESULTS: A total of 535 tympanometry studies were carried out, of which 352 were normal and 183 observations presented MEE. We observed that 12 and 16 French NGTs were not significantly associated with abnormal middle ear function, whereas 18 French NGT was significantly associated with MEE (odds ratio 2.54, 95% CI 1.42-4.55; P ‫؍‬ .01). Other variables independently associated with pathological tympanogram curves were Ramsay Sedation Scale score > 4 (odds ratio 2.42, 95% CI 1.65-3.55; P ‫؍‬ .01) and orotracheal intubation (odds ratio 5.72, 95% CI 3.40 -9.60; P ‫؍‬ .01). No intracranial infection or long-term disabilities were identified. CONCLUSIONS: MEEs and tympanometric alterations are frequent in intubated patients (32% in our study). To prevent these complications, they should receive NGTs with a diameter lower than 18 French, when feasible.

Aetiology and pathology of otitis media with effusion in adult life

“…28,30 Gonzalez Pena et al reported an association between the use of large-bore nasogastric tubes (18 French gauge) and the presence of middle-ear effusion in 100 patients. 29 The results of the other two studies did not confirm this finding. 28,30 Human immunodeficiency virus Otitis media with effusion has been reported in association with human immunodeficiency virus infection.…”

“…27 Intensive care patients Otitis media with effusion is surprisingly prevalent in patients undergoing treatment in an intensive care unit. [28][29][30] Two studies identified evidence of middleear effusion in around 50 per cent of the patients studied. 28,30 Gonzalez Pena et al reported an association between the use of large-bore nasogastric tubes (18 French gauge) and the presence of middle-ear effusion in 100 patients.…”

Middle Ear Effusion in Adult ICU Patients: A Cohort Study

“…In a recent report, González Pena et al found that 18-Fr nasogastric tubes were more highly associated with MEE than tubes with a smaller diameter. 9 They also found that sedation and orotracheal intubation were independent risk factors for abnormal tympanometry.…”

A Tutorial on Enteral Access in Adult Patients in the Hospitalized Setting

“…One study examined the incidence of middle ear effusions and altered tympanometry in intubated patients with nasogastric tubes and demonstrated that there was no increased incidence with 12 F and 14 F tubes but there was with 18 F tubes. 15 Larger diameter tubes are clearly more beneficial when decompression is the goal but should be avoided in patients who are unlikely to benefit from this feature. Sinusitis is often a difficult diagnosis to make in the critically ill patient but appears to be closely linked to the presence of nasogastric and nasoenteric tubes.…”

“…Large-bore nasogastric tubes should be replaced with smaller diameter and more pliable nasoenteric access within 5-7 days to potentially reduce morbidity and improve patient discomfort. Nasoenteric feeding tubes are commonly composed of silicone or polyurethane and generally range from [8][9][10][11][12] French in size compared with standard large-bore sump nasogastric tubes, which are [14][15][16][17][18] French.…”