Characteristics of Otologic Disease Among Patients With Primary Ciliary Dyskinesia

Two novel mutations in TBC1D32 add complexity to the oro-facial-digital syndrome

BACKGROUND

Ciliopathies are characterized by the dysfunction of cilia, being inherited retinal dystrophies (IRDs) included in sensory ciliopathies. Besides, oro-facial-digital syndrome (OFD) is caused by mutations in ciliary genes, leading to dysmorphic features. Mutations in TBC1D32 were associated to retinal dystrophy and OFD, defining this form as OFD-IX.

RESULTS

A clinical exome analysis performed on a patient presenting with OFD-IX and sensorineural hearing loss (SNHL) identified two variants in TBC1D32, one of which affects splicing, with its impact validated using a minigene assay.

CONCLUSIONS

These results suggest that SNHL may represent a new clinical feature associated with this gene.

Management of middle ear disease in pediatric primary ciliary dyskinesia

INTRODUCTION

Primary ciliary dyskinesia (PCD) adversely affects the middle ear from early childhood resulting in otitis media with effusion (OME) and conductive hearing loss (CHL). Chronic otorrhea and tympanic membrane (TM) perforation are serious postoperative complications from tympanostomy tube (TT) placement. Management of OME and CHL has been debated for decades. This study reports on a proposed management schema for the middle ear in individuals with PCD.

METHODS

A pediatric PCD cohort was retrospectively reviewed at Children's Hospital Colorado (CHCO) using electronic health record systems. Paired middle-ear/audiologic data for all subjects at their most recent CHCO visits were organized in a 4-age-group grid to compare clinical/audiologic outcomes between no-TT and TT subgroups.

RESULTS

68 PCD subjects with middle-ear and audiologic data were tabulated. No-TT and TT subgroup comparisons showed no difference in clinical (normal TM and OME prevalence) and hearing [CHL percentage and pure-tone average (PTA)] outcomes across 4 age-groups except for higher percentage of normal TM (10 to <15 years category; p = 0.006) and fewer hearing loss ears (≥15 years category; p = 0.008), both favoring the no-TT subgroup. There were 9/13 (subjects/ears) in the TT subgroup with TM perforations, and a total of 130 sets of TT and other medical/surgical procedures were performed in this sub-cohort.

CONCLUSION

Children with PCD have a high prevalence of otologic complications. A schema is proposed to restrict the indications for TT placement and guide active management of CHL with the goal of preventing adverse sequalae of OME and achieving best clinical outcomes.

Bilateral Hearing Loss in Primary Ciliary Dyskinesia: A Study of Conductive and Sensorineural Mechanisms from Pediatric and Adult Cases

Background

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that affects the respiratory and auditory systems. This study aims to assess the prevalence, type, and severity of bilateral hearing loss (HL) in PCD and Kartagener syndrome (KS) patients, examining age-related differences and chronic impacts of otologic pathologies.

Methods

A total of 19 patients (38 ears), including 6 children and 13 adults, were evaluated from June to September 2021. Comprehensive clinical examinations included otoscopy, tympanometry, and pure tone audiometry (PTA) for air and bone conduction. Tympanometry findings were compared with otoscopic results. Statistical analyses were conducted using SPSS v16.0 (SPSS Inc.; Chicago, IL, USA), with a significance threshold of P ≤ .05.

Results

Hearing loss was identified in 42.1% of patients, with conductive HL predominant in children (3 out of 4), while mixed HL was more common in adults (3 out of 4). Tympanometry results showed 57.9% type A and 42.1% type B findings, correlating with otoscopic observations. Chronic otitis media with effusion (OME) and tympanosclerosis (TS) were the primary pathologies contributing to middle ear damage. Age was significantly correlated with HL severity (P= .005). Mild HL was most common (62.5%), followed by moderate HL (25%) and moderately severe HL (12.5%).

Conclusion

This study identifies distinct age-related patterns in the type and severity of HL among PCD patients, with sensorineural components observed in adults due to progressive middle ear damage. Audiological evaluations are essential for identifying these complications. Further research is needed to optimize treatment approaches and understand the progression of HL in PCD/KS patients.

Definition of sinonasal and otological exacerbation in patients with primary ciliary dyskinesia: an expert consensus

Background

Recurrent infections of the nose, sinuses and ears are common problems for people with primary ciliary dyskinesia. While pulmonary exacerbations in primary ciliary dyskinesia are defined, there is no definition for ear-nose-throat exacerbations, a potential outcome for research and clinical trials.

Methods

We set up an expert panel of 24 ear-nose-throat specialists, respiratory physicians, other healthcare professionals and patients to develop consensus definitions of sinonasal and otological exacerbations in children and adults with primary ciliary dyskinesia for research settings. We reviewed the literature and used a modified Delphi approach with four electronic surveys.

Results

Definitions for both sinonasal and otological exacerbations are based on a combination of major and minor criteria, requiring three major or two major and at least two minor criteria each. Major criteria for a sinonasal exacerbation are 1) reported acute increase in nasal discharge or change in colour, 2) reported acute pain or sensitivity in the sinus regions and 3) mucopurulent discharge on examination. Minor criteria include reported symptoms, examination signs, doctor's decision to treat and improvement after at least 14 days. Major criteria for the otological exacerbation are 1) reported acute ear pain or sensitivity, 2) reported acute ear discharge, 3) ear discharge on examination and 4) signs of otitis media in otoscopy. Minor criteria are reported acute hearing problems, signs of acute complication, and doctor's decision to treat.

Conclusion

These definitions might offer a useful outcome measure for primary ciliary dyskinesia research in different settings. They should be validated in future studies and trials together with other potential outcomes, to assess their usability.

Primary Ciliary Dyskinesia: A Clinical Review

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous, motile ciliopathy, characterized by neonatal respiratory distress, recurrent upper and lower respiratory tract infections, subfertility, and laterality defects. Diagnosis relies on a combination of tests for confirmation, including nasal nitric oxide (nNO) measurements, high-speed videomicroscopy analysis (HSVMA), immunofluorescent staining, axonemal ultrastructure analysis via transmission electron microscopy (TEM), and genetic testing. Notably, there is no single gold standard confirmatory or exclusionary test. Currently, 54 causative genes involved in cilia assembly, structure, and function have been linked to PCD; this rare disease has a spectrum of clinical manifestations and emerging genotype-phenotype relationships. In this review, we provide an overview of the structure and function of motile cilia, the emerging genetics and pathophysiology of this rare disease, as well as clinical features associated with motile ciliopathies, novel diagnostic tools, and updates on genotype-phenotype relationships in PCD.

Association between upper and lower respiratory disease among patients with primary ciliary dyskinesia: an international study

Introduction

Nearly all patients with primary ciliary dyskinesia (PCD) report ear-nose-throat (ENT) symptoms. However, scarce evidence exists about how ENT symptoms relate to pulmonary disease in PCD. We explored possible associations between upper and lower respiratory disease among patients with PCD in a multicentre study.

Methods

We included patients from the ENT Prospective International Cohort (EPIC-PCD). We studied associations of several reported ENT symptoms and chronic rhinosinusitis (defined using patient-reported information and examination findings) with reported sputum production and shortness of breath, using ordinal logistic regression. In a subgroup with available lung function results, we used linear regression to study associations of chronic rhinosinusitis and forced expiratory volume in 1 s (FEV1) accounting for relevant factors.

Results

We included 457 patients (median age 15 years, interquartile range 10-24 years; 54% males). Shortness of breath associated with reported nasal symptoms and ear pain of any frequency, often or daily hearing problems, headache when bending down (OR 2.1, 95% CI 1.29-3.54) and chronic rhinosinusitis (OR 2.3, 95% CI 1.57-3.38) regardless of polyp presence. Sputum production associated with daily reported nasal (OR 2.2, 95% CI 1.20-4.09) and hearing (OR 2.0, 95% CI 1.10-3.64) problems and chronic rhinosinusitis (OR 2.1, 95% CI 1.48-3.07). We did not find any association between chronic rhinosinusitis and FEV1.

Conclusion

Reported upper airway symptoms and signs of chronic rhinosinusitis associated with reported pulmonary symptoms, but not with lung function. Our results emphasise the assessment and management of upper and lower respiratory disease as a common, interdependent entity among patients with PCD.