Correlating Body Mass Index with Tympanograms of Children with Symptomatic Adenoidal Hypertrophy in Owerri, South-East Nigeria

Childhood obesity poses a well-known risk to health. Almost as much as being overweight, being underweight can potentially cause medical problems. It has been inferred that being overweight/obese can contribute to abnormal middle ear pressure and possibly lead to development of otitis media with effusion in children through multiple complex mechanisms such as changes in cytokines levels, immune system dysfunction, structural and functional Eustachian tube changes via adipocytes accumulation as well as gastroesophageal reflux. These may ultimately produce otologic symptoms including hearing impairment with potential consequences in children like poor speech development and impaired learning ability. We conducted a 6-month prospective cross-sectional evaluation of children with symptomatic adenoid hypertrophy attending the Ear, Nose and Throat (ENT) clinic of Federal University Teaching Hospital, Owerri, Nigeria between January and June 2023. There were age and sex matched controls drawn from symptomless children attending Kindergarten, Nursery and Primary School sections of the nearby Alvan Ikoku Federal College of Education, Owerri, Nigeria. Both groups comprised one hundred and thirty-four (134) children each, with a male to female ratio of 1.23:1. The test group mean adenoidal-nasopharyngeal ratio (ANR) was 0.75 (S.D ± 0.13). Majority of the symptomatic children had Sade grade III adenoidal hypertrophy (58.2%) while 41.8% had grade II. The prevalence of abnormal tympanograms was 52.9% in the test group and 33.5% among the control subjects. The prevalence of abnormal body mass index (BMI) among the test group was 61.0% (underweight - 30.5%, obese - 15.6%, overweight - 14.9%) compared to 36.6% among the control group (overweight - 21.6%, obese - 9.0%, underweight - 6.0%). We found statistically significant correlation between BMI, ANR, tympanic membrane compliance and middle ear pressure. Children who were obese or overweight had more proportions of type B tympanograms (overweight - 17.6% and obese - 37.5%) whereas the underweight had more type C tympanograms (C1 - 31.7% and C2 - 12.2%). Overall, majority of children with adenoid hypertrophy (38.8%) had normal BMI, although a significant proportion (30.5%) were underweight. The underweight children with adenoid hypertrophy had the highest prevalence of abnormal tympanograms (35.2%), followed by the obese (28.2%) and the overweight (22.5%). We conclude that prevalence of abnormal tympanograms in our study was higher among children with abnormal body habitus suggesting that abnormal BMI in children correlates with development of otitis media with effusion (OME).