The link of chronic otitis media with effusion and allergy

Otitis media (OM) is a common and costly medical condition, especially in children. Most episodes of OM are associated with an upper respiratory viral infection and are short-lived and self-limiting with or without medical treatment. However, chronic OM with effusion (OME) has significant sequelae, is refractory to most medical treatments, and frequently requires surgical intervention. The pathophysiology of OME is complex and involves both eustachian tube (ET) dysfunction and middle ear pressure dysregulation. OM likely results from an increase in blood flow to and, thus, gas loss from the middle ear, in combination with a dysfunctional ET that can not resupply that gas. These processes could be induced by viral and/or allergen-driven inflammation[1]. A large body of epidemiologic and mechanistic evidence supports a role for allergic rhinitis as a risk for OM. Indeed, evidence also supports a role for histamine in both conditions. However, not all such evidence is supportive of this relationship and a causal relationship between the two conditions has not been definitively proven[1].

Eustachian tube dysfunction related to the adenoids may also have an allergy-related functional component. Allergic inflammation has been described for middle ear effusion, and some studies have reported that mast cells increase and allergic mediators release in adenoids as well. Nasal endoscopy has a key role in confirming a diagnosis of adenoid hypertrophy and/or adenoiditis and in detecting an association between adenoid inflammation/infection and otitis media with effusion, especially during infancy and early childhood [2].

Nasal allergy can affect Eustachian tube function, leading to the changes in the middle ear pressure and resulting in hearing impairment. Nasal challenges with allergen performed using rhinomanometry combined with tympanometry and PTA may be a useful diagnostic supplement in chronic OME patients [3]. The significant incidence of atopy associated with otitis media with effusion (OME) has suggested a role of allergy in the pathogenesis of OME. Analysis of inflammatory mediators indicates that the mucosa of the middle ear can respond to antigen in the same way as does the mucosa of the lower respiratory tract. Recent characterization of the mucosa and effusion from atopic patients with OME reveals a Th2 cytokine and cellular profiles consistent with an allergic response, supporting the role of allergy in OME. In addition, animal studies demonstrate that inhibiting characteristic allergy cytokines can prevent the production of middle ear effusion. As the understanding of allergy and its role in the inflammation of OME continues to deepen, this will introduce focused treatments of OME in the atopic population [4].

Literature

Skoner AR, Skoner KR, Skoner DP. Allergic rhinitis, histamine, and otitis media. Allergy Asthma Proc. 2009 Sep-Oct;30(5):470-81.

Marseglia GL, Poddighe D, Caimmi D, Marseglia A, Caimmi S, Ciprandi G, Klersy C, Pagella F, Castellazzi AM. Role of adenoids and adenoiditis in children with allergy and otitis media. Curr Allergy Asthma Rep. 2009 Nov;9(6):460-4.

3. Pelikan Z. Audiometric Changes in Chronic Secretory Otitis Media Due to Nasal Allergy. Otol Neurotol. 2009 Aug 7.

4. Luong A, Roland PS. The link between allergic rhinitis and chronic otitis media with effusion in atopic patients. Otolaryngol Clin North Am. 2008 Apr;41(2):311-23, vi.