Systemic Inflammatory Markers in Patients with Combined Otitis Media and Rhinosinusitis

Background: Otitis media and rhinosinusitis are common inflammatory disorders of the upper airway that frequently coexist due to shared anatomical and immunological pathways. Increasing evidence supports the concept of a unified airway, suggesting that inflammation of the nasal cavity and paranasal sinuses may extend to the middle ear. Objective: To evaluate systemic inflammatory markers in patients with combined otitis media and rhinosinusitis and compare them with healthy controls. Methods: This hospital-based case–control study was conducted at the Department of Otolaryngology, Al-Kindy Teaching Hospital, Baghdad, Iraq, between March 1, 2025, and December 30, 2026. A total of 140 participants were enrolled, including 70 patients diagnosed with combined otitis media and rhinosinusitis and 70 age- and sex-matched healthy controls. Clinical diagnosis was confirmed through otoscopic examination, nasal endoscopy, and radiological assessment when indicated. Venous blood samples were collected to measure systemic inflammatory markers including white blood cell count (WBC), neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet count, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin levels. Results: No significant differences were observed between groups regarding age or sex distribution (p>0.05). Patients with combined OM and RS demonstrated significantly elevated WBC (9.80±2.10 vs. 6.70±1.50 ×10⁹/L), neutrophil count (6.50±1.90 vs. 3.80±1.20 ×10⁹/L), NLR (3.50±1.20 vs. 1.40±0.60), platelet count (320.00±60.00 vs. 260.00±50.00 ×10⁹/L), PLR (160.00±40.00 vs. 95.00±30.00), CRP (12.40±5.60 vs. 3.20±1.80 mg/L), and ESR (28.60±10.20 vs. 12.30±5.40 mm/hr) compared with controls (all p < 0.001). Lymphocyte count was significantly reduced in cases (2.10±0.70 vs. 2.80±0.80 ×10⁹/L, p < 0.001). Hemoglobin was mildly but significantly lower in cases (12.60±1.40 vs. 13.20±1.30 g/dL, p = 0.02). Correlation analysis demonstrated significant associations among inflammatory indices, particularly between NLR and CRP, ESR, and neutrophil count (p