Abstract:
Eosinophilic
otitis media is actually a recent introduction. These patients may
manifest with sudden hearing loss. There may be associated bronchial
asthma and allergic rhinitis. Diagnostic criteria of this condition
are rather vague. A review of literature shows that demonstration of
eosinophils in the middle ear secretion of these patients could be
considered to be pathognomonic of this condition.
Introduction:
Eosinophils are
considered to be effectors for allergic reactions. Eosinophilic
otitis media 1 is a newly recognised entity causing
intractable middle ear pathology. This condition is characterised by
excessive accumulation of eosinophils in the middle ear cavity and is
associated with persistent middle ear effusion. These patients
usually suffer from bronchial asthma. The first description of this
condition should be credited to Koch 2 who first reported
some patients with middle ear effusion which contained lots of
eosinophils. He also added that these secretions were highly viscous
and the middle ear mucosa was pinkish in color. The term
eosinophilic otitis media was coined by Tomioka et al 3 in
1993.
Pathophysiology:
Pathophysiology
of this condition is obviously allergy. These patients commonly had
associated allergic rhinitis and branchial asthma. Eosinophils could
have been probably attracted to the middle ear cavity by the presence
of IL 5 4 inside the middle ear cavity.
Features of
Eosinophilic otitis media 5:
- Sudden deterioration of hearing
- Bronchial asthma
- Allergic rhinitis
- Intractable otitis media
- Persistent otorrhoea
Incidence:
Incidence of
eosinophlic otitis media is not clearly known. Literature search
puts it to be rather common cause of otitis media with effusion.
Managment:
Patients
diagnosed with this condition should be warned of the possibility of
sudden deterioration of hearing.
Administration
of systemic / topical steroids 6 could be of benefit in
these patients.
Antihistamines
and leukotreine receptor antogonists can also be used with benefit.
Grommet
insertion is indicated in patients with acute sudden hearing loss.
References:
- Iino Y, Kakizaki K, Katano H, Saigusa H, Kanegasaki S. Eosinophil chemoattractant in middle ear patients with eosinophilic otitis media. Clin Exp Allergy 2005;35:1370–6.
- Koch H. Allergical investigations of chronic otitis. Acta Otolaryngol 1947;62(Suppl.):1–201.
- Tomioka S, Yuasa R, Iino Y. Intractable otitis media in cases with bronchial asthma. Recent advances in otitis media. In: Mogi G, HonjoI, Ishii T, Takasaka T, editors. Proceedings of the second extraordinary international symposium on recent advances in otitis media. Amsterdam, New York: Kugler Publications; 1993. p. 183–186.
- NonakaM, Fukumoto A, Ozu C, Mokuno E, Baba S, pawankar R, et al. IL-5 and eotaxin levels in middle ear effusion and blood from asthmaticswith otitis media with effusion. Acta Otolaryngol 2003;123:383–7.
- Suzuki H, Matsutani S, Kawase T, Iino Y, Kawauchi H, Gyo K, et al. Epidemiologic surveillance of ‘‘eosinophilic otitis media’’ in Japan. Otol Jpn 2004;14:112–7 (In Japanese).
- Iino Y, Nagamine H, Kakizaki K, Komiya T, Katano H, Saruya S, et al. Effectiveness of instillation of triamcinolone acetonide into middle ear for eosinophilic otitis media associated with bronchial asthma. Ann Allergy Asthma Immunol 2006;97:761–6.
