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      Otitis media with effusion and atopy: is there a causal relationship?

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          Abstract

          Otitis Media with Effusion (OME) is an inflammatory condition of the middle ear cleft, acute or chronic, with collection of fluid in the middle ear with an intact tympanic membrane. It is a very common disease in childhood, the most frequent cause of hearing loss in childhood and often requiring surgery. OME is called chronic when the fluid in the middle ear persists for more than three months or when the episodes recur six or more times in one year. The current article covers various aspects of OME including definition, epidemiology. Pathomechanisms, risk factors, role of allergy in OME, impact of upper airway disease on OME, eosinophilic otitis media and management of OME.

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          Most cited references91

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          Total and specific IgE in nasal polyps is related to local eosinophilic inflammation.

          Nasal polyps (NPs) are characterized by eosinophilic inflammation and often coexist with asthma. However, the role of atopy and IgE in NP pathogenesis is unclear. We sought to determine whether there is an association between total and specific IgE to a variety of allergens in polyp and nonpolyp tissue and markers of eosinophilic inflammation or skin test results. Homogenates were prepared from nasal tissue of 20 patients with NPs and 20 patients without NPs and analyzed for concentrations of IL-5, IL-4, eotaxin, leukotriene (LT) C4/D4/E4, sCD23, and histamine (ELISA). Eosinophil cationic protein (ECP), tryptase, and total and specific IgE for inhalant allergens and Staphylococcus aureus enterotoxins were measured (ImmunoCAP). The concentrations of total IgE, IL-5, eotaxin, ECP, LTC4/D4/E4, and sCD23 were significantly higher in NP tissue compared with nonpolyp tissue. Total IgE was significantly correlated to IL-5, ECP, LTC4/D4/E4, and sCD23 and to the number of eosinophils in NPs. On the basis of the presence of specific IgE antibodies in tissue, 3 NP groups were defined. NP group 1 demonstrated no measurable specific IgE, and NP group 2 selected specific IgE. The third group demonstrated a multiclonal specific IgE, including IgE to S aureus enterotoxins, a high total IgE level, and a high prevalence of asthma. These studies suggest that there is an association between increased levels of total IgE, specific IgE, and eosinophilic inflammation in NPs, which may be of relevance in the pathophysiology of nasal polyposis. Similarly, the presence of specific IgE to staphylococcal enterotoxins A and B also points to a possible role of bacterial superantigens.
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            Otitis media.

            Otitis media (OM) continues to be one of the most common childhood infections and is a major cause of morbidity in children. The pathogenesis of OM is multifactorial, involving the adaptive and native immune system, Eustachian-tube dysfunction, viral and bacterial load, and genetic and environmental factors. Initial observation seems to be suitable for many children with OM, but only if appropriate follow-up can be assured. In children younger than 2 years with a certain diagnosis of acute OM, antibiotics are advised. Surgical candidacy depends on associated symptoms, the child's developmental risk, and the anticipated chance of timely spontaneous resolution of the effusion. The recommended approach for surgery is to start with tympanostomy tube placement, eventually followed by adenoidectomy. The ideal intervention for OM, however, does not yet exist, and an urgent need remains to explore new and creative options based on modern insights into the pathophysiology of OM.
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              One airway, one disease.

              The prevalence of asthma and allergic rhinitis is increasing in the general population, and a high proportion of new patients have coexisting upper and lower airway disease. Estimates show that 60 to 78% of patients who have asthma have coexisting allergic rhinitis. During the past decade, our understanding of asthma and allergic rhinitis has evolved. The historic perspective of these allergen-induced disorders as distinct and separate entities is being displaced by current thinking that they are described better as a continuum of inflammation involving one common airway. Therefore, traditional therapies originally indicated for allergic rhinitis and asthma are being reassessed to explore their potential utility in both upper and lower airway diseases. Recently, there has been a renewed interest in the role that histamines play in lower airway disease, and interest is increasing in the theory that leukotrienes, which are far more potent inflammatory mediators than histamines, play a role in upper airway disease. Given the pivotal role that leukotrienes play as potent inflammatory mediators in the pathophysiologic state of inflammation of both airways, leukotriene receptor antagonists recently have emerged as important therapeutic advances that have potential clinical utility in both asthma and allergic rhinitis.
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                Author and article information

                Contributors
                mario.zernotti@gmail.com
                pawankar.ruby@gmail.com
                iansotegui.bil@quiron.es
                hectorbade@hotmail.com
                jscroce@institutocroce.com.ar
                elham.hossny@gmail.com
                m-ebisawa@sagamihara-hosp.gr.jp
                nelson.rosario@onda.com.br
                summer_zhang1211@126.com
                dr.luozhang@139.com
                Journal
                World Allergy Organ J
                World Allergy Organ J
                The World Allergy Organization Journal
                BioMed Central (London )
                1939-4551
                14 November 2017
                14 November 2017
                2017
                : 10
                : 1
                Affiliations
                [1 ]ISNI 0000 0000 9878 4966, GRID grid.411954.c, Department of Otolaryngology, , Catholic University of Córdoba, ; Córdoba, Argentina
                [2 ]ISNI 0000 0001 2173 8328, GRID grid.410821.e, Department of Pediatrics, , Nippon Medical School, ; Tokyo, Japan
                [3 ]Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
                [4 ]Department of Pediatric Respiratory Medicine, Regional Eastern Clinic, San Francisco, Córdoba, Argentina
                [5 ]CIMER, Catholic University of Córdoba and Croce Institute, Córdoba, Argentina
                [6 ]ISNI 0000 0004 0621 1570, GRID grid.7269.a, Pediatric Allergy Unit, , Children’s Hospital, Ain Shams University, ; Cairo, Egypt
                [7 ]ISNI 0000 0004 0642 7451, GRID grid.415689.7, Department of Pediatrics, , National Sagamihara Hospital, ; Sagamihara-shi, Kanagawa Japan
                [8 ]ISNI 0000 0001 1941 472X, GRID grid.20736.30, Federal University of Parana, ; Curitiba, Brazil
                [9 ]ISNI 0000 0001 2231 8907, GRID grid.418386.0, Allergy and Clinical Immunology Department, , Centro Médico Docente La Trinidad, ; Caracas, Venezuela
                [10 ]ISNI 0000 0004 0369 153X, GRID grid.24696.3f, Department of Otolaryngology – Head and Neck Surgery, Department of Allergy, , Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, ; Beijing, China
                Article
                168
                10.1186/s40413-017-0168-x
                5684754
                51cddf16-5d88-4b22-8fe3-4eecbce3cf84
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Review
                Custom metadata
                © The Author(s) 2017

                Immunology
                ome,risk factors,infancy,inflammation; eosinophilic otititis media,allergy,rhinosinusitis
                Immunology
                ome, risk factors, infancy, inflammation; eosinophilic otititis media, allergy, rhinosinusitis

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