Tomonaga K, KuronoY, Mogi G. The role of nasal allergy in otitis media with effusion. Acta Otolaryngol (Stockh) 1988; Suppl. 458: 4147. In order to clarify the role of Type I immunologic reactions in the etiology of otitis media with effusion (OME), kindergarten and elementary school children were given routine nasal allergy (NA) tests and otologic tests. Several children among them were evaluated for eustachian tube (ET) function before and after the intranasal histamine challenge, using the inflationdeflation test, and the nine-step inflation and deflation tympanometric test. The results clarified that NA-patients showed a high ratio (21%) of complication with OME, and that OME-patients showed a high ratio (50%) of complication with NA. It was also found that the incidence of tubal dysfunction was higher in OME-patients with NA than in OMEpatients without NA. The man period of time between the removal and replacement of a tympanostomy tube was 11 months in OME-patients with NA who underwent hyposensitization; whereas the mean period of time was 2 months in OME-patients with NA who underwent no treatment for NA. The findings of the present study suggest that NA affects tubal function (even if the effect is temporary), and that NA may be a risk factor in OME-prone children. Key words: otitis media with effusion, nasal allergy, eustachian tube function. Acta Otolaryngol Downloaded from informahealthcare.com by University of Queensland on 02/03/15 For personal use only. b>a, a>c @<0.01); e>d, d>f(pg, g>i (pj, j>l (pm, m>o @<0.01). Acta Otolaryngol Downloaded from informahealthcare.com by University of Queensland on 02/03/15 For personal use only.

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In order to investigate the influence of nasal allergic reactions on the clearance of middle ear effusion, an animal model of nasal allergy and otitis media with effusion was produced in the same guinea pigs simultaneously by passive sensitization with serum of homologous animals containing IgE antibodies (for nasal allergy) and by inoculation of immunocomplex into the tympanic cavity (for otitis media with effusion). Usually, middle ear effusion appeared within 2 to 3 days and disappeared within 7 to 9 days after the inoculation of immunocomplex. Three days after the inoculation of immunocomplex, intranasal antigen challenge was performed three times daily and continued until the animals were killed. Disappearance of middle ear effusion appeared to be delayed in animals in which nasal allergic reactions were induced. Middle ear effusion was not found in those ears that were not inoculated with immunocomplex. Findings of the present study indicate that IgE-mediated allergic reactions of the mucous membrane lining the nose, nasopharynx, and eustachian tube constitute a factor indicative of a chronic state of disease, rather than a cause of otitis media with effusion.

\s=b\Bacteriologic investigation of middle ear effusion (MEE), external ear canal, and the nasopharynx was carried out on 458 patients with otitis media with effusion. Staphylococcus epidermidis was the most common bacteria in MEE, even after excluding the contaminants from the external ear canal, which had the same value of minimal inhibitory concentration as the paired MEE. The bacterial agreement of S epidermidis between MEE and the nasopharynx was extremely rare in contrast with Haemophilus influenzae, Streptococcus pneumoniae, and Branhamella catarrhalis, although the organism was also frequently isolated from the nasopharynx. Staphylococcus aureus, having the same minimal inhibitory concentration as that in the nasopharynx, was more frequently found in MEE than S epidermidis. The results suggest that S epidermidis found in MEE is not a pathogen, but rather a contaminant in many instances. Staphylococcus aureus seems to be a causative agent in otitis media with effusion. otitis media with effusion (OME) had in general been assumed to be sterile until Senturia et al1 were able to identify bacteria by means of smears and cultures of middle ear effusion (MEE) from children with OME. Since then, many investiga¬ tors26 have reported on the presence of a high percentage of bacteria in MEEs.Haemophilus influenzae, Streptococcus pneumoniae, and Branhamella catarrhalis are frequently found in MEEs, and are commonly considered pathogens of OME.5-6 How¬ ever, whether Staphylococcus aureus and Staphylococcus epidermidis, also frequently present in MEEs, are caus¬ ative agents in OME is still controver¬ sial. Senturia et al1 found that the most common bacterial species in MEE was S epidermidis, and stated that bacteria from the external ear canal had contaminated the effusions.Riding et al4 considered S aureus and S epidermidis as "doubtful patho¬ gens," because these organisms were frequently found in both the external ear canal and the middle ear. On the other hand, Bernstein et al' demon¬ strated the presence of antibodycoated coagulase-negative staphylo¬ cocci in various types of effusions.They suggested that this organism may not always be a contaminant, but that it may play a role in the patho¬ genesis. Feigin et al8 were able to isolate S epidermidis in pure culture from purulent MEE in a few children with acute otitis media.To clarify this problem, detailed bactériologie analysis of OME is nec¬ essary. Bernstein et al9 determined the biochemical profiles and patterns of antibiotic susceptibility of coagulase-negative staphylococci isolated from MEEs, ear canals, and adenoid tissues. In this study, the external ear canal was thoroughly sterilized, and further bacterial identification was attempted by determining the mini¬ mal inhibitory concentration (MIC) of several antimicrobial agents against the bacterial isolates from patients with OME. The findings of the orga¬ nisms from the external ear canal, MEE, and the nasopharynx were investigated in detail, and the possi¬ bility of S epidermidis and S aureus as causa...

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