Association of Otitis Media With Effusion and Allergy as Demonstrated by Intradermal Skin Testing and Eosinophil Cationic Protein Levels in Both Middle Ear Effusions and Mucosal Biopsies

Abstract

This study was performed to ascertain the role of allergy, as defined by skin testing and histochemical markers, in the pathogenesis of otitis media with effusion (OME). A historical perspective of allergy as it relates to OME is presented. The study included 89 patients: 48 with persistent effusion but no recent acute infection, 25 with purulent OME complicated by a superimposed infection, and 16 control subjects. All 89 patients had persistent effusion for more than 2 months and subsequently required the placement of tympanostomy tubes. Allergy was defined using the radioallergosorbent test (RAST), serum immunoglobulin E (IgE) levels, and skin tests. Allergies were present in 97% of the patients with nonacute OME. The relationship between allergy and OME was corroborated clinically in 89% of patients and was also substantiated by elevated levels of effusion eosinophil cationic protein (ECP) in 87.5% of OME patients. Histologically, polyclonal antibody staining for ECP demonstrated the presence of eosinophils in middle ear mucosal biopsy specimens. This study confirms that OME is a sign of allergic inflammation in the middle ear that is associated with an increase in eosinophils and a concomitant release of ECP into the effusion in individuals with allergy demonstrated by skin testing.

Intractable Otitis Media with Eosinophils: Importance of Diagnosis and Validity of Treatment for Hearing Preservation

“…With progress in basic research on allergies [1] , the middle ear was shown to be an immunoreactive site, both experimentally and clinically [4][5][6] . Recently, Iino et al [7] and Nagamine et al [8] reported OM with eosinophilenriched secretions of which the macroscopic appearance was similar to Koch type OM.…”

Eosinophils and neutrophils in biopsies from the middle ear of atopic children with otitis media with effusion

“…Significant differences between control and patients with OME are indicated by *(p < 0.05), **(p < 0.01), and ***(p < 0.001), respectively; ns = not significant. compared to allergic asthma, and this would again emphasize the multifactorial characteristics of OME [31,32].…”

“…In the airways, eosinophilic inflammation has been shown to correlate with the severity of allergic symptoms [23,30]. It has been reported that the majority of patients selected randomly with non-acute OME had elevated levels of ECP in their effusion [31], which suggests a relation between OME, allergy, and eosinophils. Our present findings might lend further support to this notion.…”

Comorbidities of Allergic Rhinitis

“…Furthermore, it has been found that a reduction in the size of the lumen in an inflamed E-tube could impede mucociliary function, thus delaying clearance of acute infective middle ear effusion, leading to recurrent OME (Alles et al, 2001). Several studies analyzing middle ear mucosa and effusions in atopic patients with OME have demonstrated that the composition of the inflammatory substrate in acute otitis media is similar to the type I late-phase allergic response seen in other areas of the respiratory tract, such as in AR, chronic RS, and asthma (Nguyen et al, 2004;Sobol et al, 2002;Hurst, 1996). The middle ear effusions of atopic patients with OME showed significantly higher levels of eosinophils, T lymphocytes, and IL-4 mRNA+ cells (p<0.01) and significantly lower levels of neutrophils and IFN-γ mRNA+ cells (p<0.01) compared to non-atopic patients with OME (Nguyen et al, 2004).…”