Optimal control of asthma improved eosinophilic otitis media

Abstract

BackgroundEosinophilic otitis media (EOM) is often associated with comorbid asthma. The middle ear cavity is part of the upper airway. Therefore, EOM and asthma can be considered to be a crucial part of the “one airway, one disease” phenomenon. Based on the concept of one airway, one disease in the context of allergic rhinitis and asthma, optimal level of inhalation therapy for better asthma control leads to improvement in allergic rhinitis.ObjectiveWe conducted a pilot study to determine whether appropriate strengthening of inhalation therapy for asthma is effective for EOM.MethodsFifteen patients with EOM and comorbid asthma were enrolled in this study. Eight patients were randomly selected and administered appropriately strengthened inhalation therapy for asthma (strengthened group). The effect of the therapy on EOM was assessed by comparing a questionnaire for ear symptoms, clinical characteristic score, pure tone audiometry, blood tests and temporal bone computed tomography (CT) examination before and after the therapy. Seven other EOM + asthma patients without the above mentioned therapy were included as controls.ResultsIn the strengthened group, the score of ear symptoms, clinical characteristics score, peripheral blood eosinophil count, CT score, and air conduction hearing level improved significantly after strengthening the inhalation therapy, but not in the control group. The lung function tests (forced vital capacity [%predicted], forced expiratory volume in 1 second [FEV1] [L], and FEV1 [%predicted]) significantly increased in the strengthened group after the therapy, but not in the control group.ConclusionIn this study we demonstrated that EOM improved along with improved lung function when appropriately optimal inhalation therapy was implemented in patients with EOM and asthma. Administration of optimizing therapy for asthma might be effective for concomitant EOM.

Regulation of Interaction Between the Upper and Lower Airways in United Airway Disease

“…In united airway disease characterized by eosinophilic inflammation, there are close relationships between not only the upper and lower airway inflammation but also between the middle ear and airway disease [ 5 , 18 , 19 ]. However, there is less evidence regarding the interaction between otitis media and AR or ECRS.…”

“…Nguyen et al suggested that similar allergic inflammation linked AR and otitis media with effusion and that the middle ear is a part of the united airway in atopic individuals [ 18 ]. Seo et al reported that eosinophilic otitis media was associated with asthma severity [ 20 ], and the treatment of asthma improved eosinophilic otitis media [ 19 ]. Although little is known about the precise mechanisms for these relationships, it is postulated that chemical mediators released during an allergic reaction in the nose affect the middle ear through the nasolacrimal duct and lacrimal system or indirectly via the blood stream [ 19 , 21 ].…”

Rapid and remarkable effectiveness of benralizumab for treating severe bronchial asthma with intractable eosinophilic rhinosinusitis and eosinophilic otitis media: A case report

“…It has been documented that optimal control of asthma improved EOM or AR [ [19] , [20] , [21] ], and these reports led us to postulate “one airway, one disease”. In our patient, the onset of airway disease started with AR in her early life, followed by ECRS in middle age.…”

CD11c(+) dendritic cells coexpressing thymic stromal lymphopoietin receptor in animal model of eosinophilic otitis media

“…EOM is frequently associated with eosinophilic inflammatory airway conditions, such as bronchial asthma and eosinophilic chronic rhinosinusitis. It has been reported that EOM was improved by optimal treatment and the control of comorbid bronchial asthma, which appears to reflect the concept of “one airway, one disease” [ 4 ].…”