Conotruncal cardiac anomalies and otitis media.
BACKGROUND
The neural crest influences the differentiation of the branchial arches, including the precursor tissue of the cardiac outflow tract and the eustachian tubes. Abnormal eustachian tubes are associated with otitis media. We hypothesized a relationship between conotruncal anomalies and eustachian tube anomalies.


METHODS
We surveyed 115 nonsyndromic patients, aged 5 to 20 years, attending a state-run pediatric cardiology clinic. The cardiac anomalies were conotruncal (transposition of the great arteries, tetralogy of Fallot, or aortic stenosis) or nonconotruncal (atrial septal defect, tricuspid atresia, atrioventricular canal). Tympanic membrane photographs were categorized independently by two physicians as to normal, abnormal (scarred or other indication of otitis proneness), or indeterminate.


RESULTS
For the 37 patients who had both ears categorized as normal or abnormal by both physicians, 20 of the 26 with a conotruncal anomaly had evidence of otitis media. In contrast, only 4 of 11 with nonconotruncal cardiac anomaly had evidence of otitis (p < 0.03; relative risk [conotruncal vs nonconotruncal], 5.83; 95% confidence interval, 1.26 to 26.95).


CONCLUSIONS
The concept is supported that a neural crest determined branchial field defect influences the development of the cardiac outflow tract and the eustachian tubes. Children with congenital cardiac conotruncal anomalies are otitis media prone.
Todd
J L
JL
Department of Pediatrics (Cardiology), Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Todd
N W
NW
D000293:Adolescent; D000328:Adult; D001024:Aortic Valve Stenosis / Q000150:complications; D001934:Branchial Region / Q000002:abnormalities / Q000196:embryology; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000473:pathology; D016001:Confidence Intervals; D004694:Endocardial Cushion Defects / Q000150:complications; D005064:Eustachian Tube / Q000002:abnormalities* / Q000196:embryology; D006321:Heart / Q000196:embryology; D006330:Heart Defects, Congenital / Q000145:classification / Q000150:complications*; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006801:Humans; D009432:Neural Crest / Q000002:abnormalities / Q000196:embryology; D010033:Otitis Media / Q000150:complications*; D010781:Photography; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000150:complications; D014188:Transposition of Great Vessels / Q000150:complications; D018785:Tricuspid Atresia / Q000150:complications; D014432:Tympanic Membrane / Q000473:pathology