1
|
Zahid A, Wilson JC, Grice ID, Peak IR. Otitis media: recent advances in otitis media vaccine development and model systems. Front Microbiol 2024; 15:1345027. [PMID: 38328427 PMCID: PMC10847372 DOI: 10.3389/fmicb.2024.1345027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Otitis media is an inflammatory disorder of the middle ear caused by airways-associated bacterial or viral infections. It is one of the most common childhood infections as globally more than 80% of children are diagnosed with acute otitis media by 3 years of age and it is a common reason for doctor's visits, antibiotics prescriptions, and surgery among children. Otitis media is a multifactorial disease with various genetic, immunologic, infectious, and environmental factors predisposing children to develop ear infections. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common culprits responsible for acute otitis media. Despite the massive global disease burden, the pathogenesis of otitis media is still unclear and requires extensive future research. Antibiotics are the preferred treatment to cure middle ear infections, however, the antimicrobial resistance rate of common middle ear pathogens has increased considerably over the years. At present, pneumococcal and influenza vaccines are administered as a preventive measure against otitis media, nevertheless, these vaccines are only beneficial in preventing carriage and/or disease caused by vaccine serotypes. Otitis media caused by non-vaccine serotype pneumococci, non-typeable H. influenza, and M. catarrhalis remain an important healthcare burden. The development of multi-species vaccines is an arduous process but is required to reduce the global burden of this disease. Many novel vaccines against S. pneumoniae, non-typeable H. influenza, and M. catarrhalis are in preclinical trials. It is anticipated that these vaccines will lower the disease burden and provide better protection against otitis media. To study disease pathology the rat, mouse, and chinchilla are commonly used to induce experimental acute otitis media to test new therapeutics, including antibiotics and vaccines. Each of these models has its advantages and disadvantages, yet there is still a need to develop an improved animal model providing a better correlated mechanistic understanding of human middle ear infections, thereby underpinning the development of more effective otitis media therapeutics. This review provides an updated summary of current vaccines against otitis media, various animal models of otitis media, their limitations, and some future insights in this field providing a springboard in the development of new animal models and novel vaccines for otitis media.
Collapse
Affiliation(s)
- Ayesha Zahid
- Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Jennifer C. Wilson
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - I. Darren Grice
- Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - Ian R. Peak
- Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
| |
Collapse
|
2
|
Kikuchi S, Yoshida S, Sugiyama T, Iino Y. Myringoplasty for Eosinophilic Otitis Media. Otol Neurotol 2023; 44:572-577. [PMID: 37231536 DOI: 10.1097/mao.0000000000003904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Surgical intervention of eosinophilic otitis media (EOM) has been considered contraindicated because middle ear surgery is associated with a risk of deafness. Myringoplasty is believed to be less invasive. Therefore, we analyzed the surgical results of myringoplasty for perforated eardrums in patients with EOM treated by biological drugs (biologics). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Nine ears of seven patients with EOM with eardrum perforation associated with bronchial asthma were treated with add-on biologics; myringoplasty was then performed. The controls comprised 17 ears of 11 patients with EOM treated by myringoplasty without biologics. INTERVENTIONS The EOM status of each patient of both groups was assessed using severity scores, hearing acuity, and temporal bone computed tomography scores. MAIN OUTCOME MEASURES Preoperative and postoperative changes in severity scores and hearing acuity, postoperative closure of the perforation, and relapse of EOM. RESULTS Severity scores significantly decreased after the use of biologics but did not change after myringoplasty. One patient developed postoperative relapse of middle ear effusion (MEE); in the control group, however, 10 ears developed recurrence of MEE. Significant improvement of the air conduction hearing level was obtained in the biologics group. No patients showed deterioration of the bone conduction hearing level. CONCLUSIONS This is the first report to describe successful surgical interventions with add-on biologics for patients with EOM. In the era of biologics, surgical interventions such as myringoplasty will be indicated to improve hearing and to avoid recurrence of MEE in patients with EOM with perforated eardrums, with the use of biologics.
Collapse
Affiliation(s)
- Saori Kikuchi
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saeko Yoshida
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Tomonori Sugiyama
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | | |
Collapse
|
3
|
Yoshida N. Intractable otitis media - Pathogenesis and treatment of Eosinophilic otitis media (EOM) and otitis media with Antineutrophil cytoplasmic antibody (ANCA) -associated vasculitis (OMAAV). Auris Nasus Larynx 2023; 50:171-179. [PMID: 35934599 DOI: 10.1016/j.anl.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
Abstract
Intractable otitis media is resistant to antimicrobial therapy, tympanostomy ventilation tube insertion, and surgery. In children, intractable acute otitis media, pathological tympanic membrane due to prolonged otitis media with effusion (OME), tympanic membrane atelectasis, and adhesive otitis media are common. Contrarily, in adults, otitis media caused by drug-resistant pathogens, tuberculous otitis media, cholesterol granuloma, malignant otitis externa (skull base osteomyelitis), eosinophilic otitis media (EOM), and otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) are common and require differentiation. Among them, EOM is increasing along with eosinophilic upper respiratory tract diseases, such as bronchial asthma and eosinophilic chronic rhinosinusitis (ECRS), a subgroup of chronic rhinosinusitis with nasal polyps (CRSwNP). EOM is associated with adult-onset bronchial asthma and is characterized by viscous middle ear effusion and middle ear mucosa thickness with eosinophilic infiltration, which requires treatment with glucocorticoids according to disease activity and symptoms. Recently, OMAAV was proposed because of the similarities in clinical features and therapeutic effects. The clinical course of OMAAV is characterized by a relatively rapid increase in the bone conductive hearing threshold, which progresses over 1-2 months, without response to antimicrobial agents or tympanostomy ventilation tube insertion, and in some cases, is complicated by facial paralysis and hypertrophic pachymeningitis. This new concept may explain the pathogenesis and clinical presentation of many cases of intractable otitis media, the cause of which was previously unknown. Although making a diagnosis of OMAAV is relatively easy based on the clinical course, such as vascular dilatation of the tympanic membrane and positive ANCA titer, it is often difficult because the ANCA titer becomes negative with previous administration of glucocorticoids. In adults with intractable otitis media, ANCA titers must be measured before glucocorticoid administration. Treatment consisted of remission induction therapy with a combination of glucocorticoids and immunosuppressive drugs.
Collapse
Affiliation(s)
- Naohiro Yoshida
- Department of Otolaryngology- Head and Neck Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| |
Collapse
|
4
|
Eosinophilic Otitis Media: Modern Aspects of Pathogenesis, Clinical Features, Diagnosis and Treatment. Indian J Otolaryngol Head Neck Surg 2022; 74:132-140. [PMID: 36032916 PMCID: PMC9411392 DOI: 10.1007/s12070-020-01903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022] Open
Abstract
Eosinophilic otitis media (EOM) is an inflammatory chronic disease of the middle ear, characterized by the presence of a particularly viscous effusion with a high content of protein toxins of eosinophilic origin in the middle ear cavity. The pathology has relationship with bronchial asthma, allergic rhinitis and chronic rhinosinusitis with nasal polyps. EOM is characterized by a sluggish course, a tendency to relapse, which can lead to a gradual hearing decrease up to complete deafness. In this paper, we reviewed the international literature with special attention to pathogenesis and treatment management.
Collapse
|
5
|
Magdy M, Elmowafy E, Elassal M, Ishak RA. Localized drug delivery to the middle ear: Recent advances and perspectives for the treatment of middle and inner ear diseases. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
6
|
汪 志, 陆 月, 窦 晓, 刘 谦, 罗 彬, 杨 海. [Analysis of related factors between sudden sensorineural hearing loss and serum indices base on artificial intelligence and big data]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:977-980. [PMID: 33254313 PMCID: PMC10133127 DOI: 10.13201/j.issn.2096-7993.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 06/12/2023]
Abstract
Objective:The etiology and pathophysiologic mechanism of sudden sensorineural hearing loss are undefined. We will use artificial intelligence and big data methods to explore the correlation between sudden sensorineural hearing loss and serum indices. Method:A total of 1218 patients with sudden deafness admitted to Sun Yat-sen Memorial Hospital were selected as the experimental group, 95 861 healthy subjects were randomly selected as the control group at the same period. Serum biochemical indexes in two groups were collected and analyzed by TreeNet and CART machine learning algorithms, to screen out highly correlated indicators with sudden sensorineural hearing loss and dig out a set of clinical features for people with high risk of sudden sensorineural hearing loss. Result:It was found that high prevalence rate of sudden sensorineural hearing loss is related to eosinophils, reticulocyte and fibrinogen. The areas under the receiver operator characteristic curves(ROC-AUC) were exploited to evaluate the prediction performance of TreeNet model. Overall the TreeNet model has provided high predictive ability by ROC curve, achieving AUC of 0.99, both recall and accuracy rate of 99.90%. Conclusion:There is significant difference between sudden deadness and normal people in serum biochemical indexes. Eosinophil is the first important indicator to distinguish sudden sensorineural hearing loss. Treenet model has important referenced significance for the screening and diagnosis of sudden sensorineural hearing loss.
Collapse
Affiliation(s)
- 志伟 汪
- 暨南大学附属珠海医院(珠海市人民医院)耳鼻咽喉头颈外科(广东珠海,519000)Department of Otolaryngology-Head and Neck Surgery, Zhuhai Hospital Affiliated with Ji'nan University(Zhuhai People's Hospital), Zhuhai, 519000, China
| | - 月文 陆
- 中山大学新华学院听力与言语科学系Department of Hearing and Speech Science, Xinhua College of Sun Yat-sen University
| | - 晓辉 窦
- 暨南大学附属珠海医院(珠海市人民医院)耳鼻咽喉头颈外科(广东珠海,519000)Department of Otolaryngology-Head and Neck Surgery, Zhuhai Hospital Affiliated with Ji'nan University(Zhuhai People's Hospital), Zhuhai, 519000, China
| | - 谦虚 刘
- 暨南大学附属珠海医院(珠海市人民医院)耳鼻咽喉头颈外科(广东珠海,519000)Department of Otolaryngology-Head and Neck Surgery, Zhuhai Hospital Affiliated with Ji'nan University(Zhuhai People's Hospital), Zhuhai, 519000, China
| | - 彬 罗
- 暨南大学附属珠海医院(珠海市人民医院)耳鼻咽喉头颈外科(广东珠海,519000)Department of Otolaryngology-Head and Neck Surgery, Zhuhai Hospital Affiliated with Ji'nan University(Zhuhai People's Hospital), Zhuhai, 519000, China
| | - 海弟 杨
- 中山大学孙逸仙纪念医院耳鼻咽喉科Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| |
Collapse
|
7
|
Hara R, Kudo N, Suzuki S, Miura T, Matsubara A. CD11c(+) dendritic cells coexpressing thymic stromal lymphopoietin receptor in animal model of eosinophilic otitis media. Asia Pac Allergy 2020; 10:e41. [PMID: 33178566 PMCID: PMC7610081 DOI: 10.5415/apallergy.2020.10.e41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background Eosinophilic otitis media (EOM) is an intractable middle ear disease often associated with eosinophilic inflammatory airway conditions. Recently, dendritic cells (DCs) have been indicated as an essential component of Th2 allergic inflammation, such as bronchial asthma. DCs are activated by thymic stromal lymphopoietin (TSLP), an epithelial cell-derived cytokine. However, the relationship between TSLP and DCs in EOM remains unknown. Objective This study aimed to investigate the relationship between DCs and TSLP and to determine the involvement of DCs in EOM in an animal model. Methods Hartley guinea pigs were used as the animal model. Daily ovalbumin (OVA) stimulation of the middle ear was performed for 7 or 14 days. The temporal bone was dissected on the last day of stimulation, and paraffin-embedded sections were prepared. Immunostaining and immunofluorostaining for TSLP receptor (TSLPR) and CD11c, a surface marker of DCs, were performed. Results We found CD11c-immunopositive cells in the submucosal area of the middle ear epithelium, particularly around the eustachian tube. TSLPR-immunopositive cells exhibited a similar distribution as CD11c-positive cells. Conclusion CD11c positive DCs coexpressing TSLPR were recruited after OVA challenge which might activate Th2 allergic reaction.
Collapse
Affiliation(s)
- Ryutaro Hara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naomi Kudo
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoshi Suzuki
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoya Miura
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
8
|
Yu L, Wang J, Liu K. Role of periostin in ECRS. Eur Arch Otorhinolaryngol 2020; 278:2665-2672. [PMID: 32954441 PMCID: PMC8266702 DOI: 10.1007/s00405-020-06369-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022]
Abstract
Periostin, an extracelluar matrix protein belonging to the fasciclin family, has been reported to play a key role in the process of Th2-inflammation disease. As eoshinophilic chronic rhinosinusitis has a higher incident rate, studies show that periostin has participated in the process of inflammation and remodeling. This review mainly to summarize researches of periostin in ECRS and to investigate the clinical significance and expression of periostin.
Collapse
Affiliation(s)
- Lei Yu
- Weihai Municipal Hospital, Weihai, China.
| | | | - Kai Liu
- Weihai Municipal Hospital, Weihai, China
| |
Collapse
|
9
|
Čvorović L, Trivić A, Dudvarski Z, Jotić A, Folić M, Arsović N, Bukumirić Z, Grgurević U, Vojvodić D, Perić A. Is otitis media with effusion associated with Samter's triad a new nosological entity? A preliminary report on inflammatory mediator production. Eur Arch Otorhinolaryngol 2020; 278:1835-1843. [PMID: 32785783 DOI: 10.1007/s00405-020-06276-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Otitis media with effusion (OME) associated with Samter's triad (ST) is a difficult entity to treat. The aim of study was an investigation of the middle ear and nasal production of inflammatory mediators (IM) in patients with ST and analysing differences between them and controls. METHODS Prospective case-control study. Nineteen patients with OME (five had allergic rhinitis, four had nasopharyngeal lymphoid hyperplasia, five had no evident sino-nasopharyngeal disease and five had confirmed ST) and 15 healthy participants were included. The concentrations of IM interleukin-1 beta (IL-1β), interferon-alpha 2 (IFN-α2), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23 and IL-33 were measured in nasal and middle ear secretions. RESULTS There was a difference that was close to a level of statistical significance only for IL-1β levels in middle ear fluid (p = 0.052) between the ST subgroup and the other patients with OME. Also, we found a significant difference for IL-23 in nasal secretions between these subgroups (p = 0.040), whereas the difference in nasal fluid IL-33 was close to a level of statistical significance (p = 0.052). There was a significant difference in nasal concentrations of IL-1β, IFN-α2, MCP-1, IL-8, IL-18 and IL-33 (p < 0.001, p = 0.005, p = 0.008, p = 0.011, p = 0.011 and p = 0.011, respectively) between the OME group and the healthy subjects. There were significant positive correlations between concentrations of IL-1β, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-17A, IL-18 and IL-33 (p < 0.001, p < 0.001, p = 0.002, p = 0.028, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively) in nasal and middle ear secretions. CONCLUSION This preliminary report showed some differences in IM production between the patients with OME associated with ST and those without it. Our results suggest a uniformity of the production of nasal and middle ear IM and supported the concept of a united airway respiratory disease.
Collapse
Affiliation(s)
- Ljiljana Čvorović
- Faculty of Medicine, School of Medicine, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia.
| | - Aleksandar Trivić
- Faculty of Medicine, School of Medicine, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Zoran Dudvarski
- Faculty of Medicine, School of Medicine, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Ana Jotić
- Faculty of Medicine, School of Medicine, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Miljan Folić
- Faculty of Medicine, School of Medicine, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Nenad Arsović
- Faculty of Medicine, School of Medicine, Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Zoran Bukumirić
- Faculty of Medicine, Institute for Medical Statistics, University of Belgrade, Belgrade, Serbia
| | - Uglješa Grgurević
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, Belgrade, Serbia
| | - Danilo Vojvodić
- Division of Clinical and Experimental Immunology, Military Medical Academy Faculty of Medicine, Institute for Medical Research, Belgrade, Serbia
| | - Aleksandar Perić
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, Belgrade, Serbia
| |
Collapse
|
10
|
Daval M, Picard H, Bequignon E, Bedbeder P, Coste A, Ayache D, Escabasse V. Chronic otitis media with effusion in chronic sinusitis with polyps. EAR, NOSE & THROAT JOURNAL 2018; 97:E13-E18. [PMID: 30138520 DOI: 10.1177/014556131809700803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The relationship between otitis media with effusion (OME) and chronic rhinosinusitis with nasal polyposis (CRSwNP) remains unclear. We conducted a cross-sectional study of 80 consecutively presenting patients-42 males and 38 females, aged 15 to 76 years (median: 48)-who were diagnosed with CRSwNP. Our aim was to ascertain the prevalence of OME in CRSwNP patients, to determine whether the severity of CRSwNP affected OME, and to identify risk factors for OME in CRSwNP patients. The severity of CRSwNP was assessed on the basis of nasal symptoms, endoscopic nasal examinations, and Lund-Mackay staging scores. In addition to demographic data, we obtained information on each patient's history of otitis, otoscopic findings, and the results of pure-tone audiometry and tympanometry. We then compared the data between CRSwNP patients with OME (n = 20) and those without (n = 60). In the OME group, a conductive hearing loss was present in 16 patients (80.0%); all patients in the control group had normal hearing. With regard to symptoms, only rhinorrhea appeared to be more common in patients with OME than in those without, although the difference was not statistically significant. We found no significant difference in nasal polyposis grades between the two groups. Also, we found no correlations between the risk of OME and previous surgical treatment, asthma, allergy, aspirin intolerance, aspirin and/or NSAID intolerance, aspirin and/or sulfite intolerance, and aspirin-exacerbated respiratory disease. Based on our findings, we conclude that OME occurs frequently during the evolution of CRSwNP, even when the nasal disease is well controlled. This finding suggests the possible presence, in OME and/or CRSwNP, of a global inflammatory process that involves the epithelium in both the middle ear and upper airway.
Collapse
Affiliation(s)
- Mary Daval
- Department of Otorhinolaryngology-Head and Neck Surgery, Hôpital Intercommunal de Créteil, Créteil, France
| | | | | | | | | | | | | |
Collapse
|
11
|
Sone M. Inner ear disturbances related to middle ear inflammation. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 79:1-7. [PMID: 28303055 PMCID: PMC5346614 DOI: 10.18999/nagjms.79.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The inner and middle ear are connected mainly through round and oval windows, and inflammation in the middle ear cavity can spread into the inner ear, which might induce a disturbance. In cases with intractable otitis media, attention should also be paid to symptoms related to the inner ear. In this paper, middle ear inflammation and related inner ear disturbances are reviewed with a focus on representative middle ear diseases (such as acute otitis media, chronic otitis media, otitis media with anti-neutrophil cytoplasmic antibody-associated vasculitis, eosinophilic otitis media, cholesteatoma with labyrinthine fistula, and reflux-related otitis media). Their clinical concerns are then discussed with reference to experimental studies. In these diseases, early diagnosis and adequate treatment are required to manage not only middle ear but also inner ear conditions.
Collapse
Affiliation(s)
- Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
12
|
Proposal of a Treatment Strategy for Eosinophilic Otitis Media Based on Middle Ear Condition. Otol Neurotol 2018; 39:e671-e678. [DOI: 10.1097/mao.0000000000001912] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Iino Y, Takahashi E, Ida S, Kikuchi S. Clinical efficacy of anti-IL-5 monoclonal antibody mepolizumab in the treatment of eosinophilic otitis media. Auris Nasus Larynx 2018; 46:196-203. [PMID: 30122651 DOI: 10.1016/j.anl.2018.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/16/2018] [Accepted: 07/24/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Eosinophilic otitis media (EOM) is an intractable otitis media characterized by a highly viscous effusion containing eosinophils, and it is mostly associated with bronchial asthma. Recently, anti-IL-5 therapy using mepolizumab has been reported to be effective for patients with severe and refractory eosinophilic bronchial asthma. EOM shows accumulation of eiosinophils in the middle ear effusion and most EOM patients have high numbers of peripheral blood eosinophils. Therefore, we carried out a retrospective study to determine whether anti-IL-5 therapy is also effective in the treatment of EOM. PATIENTS AND METHODS Nine patients with EOM associated with bronchial asthma received the anti-IL-5 agent mepoliumab as an add-on therapy for at least 6 months (mepolizumab group). They were evaluated by EOM severity scores, symptom scores, bone conduction hearing levels, and surrogate markers before and after receiving the anti-IL-5 therapy. Thirteen EOM patients associated with bronchial asthma who did not receive the anti-IL-5 therapy were also included as controls (control group). RESULTS The severity scores of most patients in the mepolizumab group were dramatically reduced at 3 months after the initiation of this therapy and, as therapy continued, they further decreased to levels significantly lower than the baseline. However, two patients with a granulation type of EOM showed minimal improvement from the therapy. The severity scores of control patients showed no significant changes during the study period. Significant deterioration of the bone conduction hearing levels was not observed in either group. The number of peripheral blood eosinophils was significantly reduced, and eosinophils were scarcely observed in the middle ear effusion and middle ear mucosa after the mepolizumab therapy. CONCLUSIONS Anti-IL-5 therapy using mepolizumab was effective at inhibiting eosinophilic recruitment to the middle ear in patients with EOM. However, this therapy showed minimal effect on patients with the granulation type of EOM. Therefore, this therapy may be a viable treatment option for refractory EOM without severe mucosal change.
Collapse
Affiliation(s)
- Yukiko Iino
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, 115-0053, Tokyo, Japan.
| | - Eri Takahashi
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, 115-0053, Tokyo, Japan
| | - Saeko Ida
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, 115-0053, Tokyo, Japan
| | - Saori Kikuchi
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, 115-0053, Tokyo, Japan
| |
Collapse
|
14
|
Miura T, Matsubara A, Kudo N, Hara R, Takahata J, Sasaki A. The expression of thymic stromal lymphopoietin in patients and animal models with eosinophilic otitis media. Acta Otolaryngol 2018; 138:447-451. [PMID: 29272985 DOI: 10.1080/00016489.2017.1416170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In the present study, we aimed to clarify the expression of thymic stromal lymphopoietin (TSLP), a key trigger of Th2-type allergic disease, in the middle ear mucosa of eosinophilic otitis media (EOM). METHODS An immunohistological study of TSLP was conducted in patients with EOM and in animal models of EOM constructed by intraperitoneal and intratympanic injection of ovalbumin for 7 and 14 days. In addition, the messenger RNA (mRNA) expression of TSLP in the middle ear mucosa of the animal models was analyzed using real-time PCR, and was compared with that of the control animals. RESULTS Immunoreactivities for TSLP were observed in the middle ear mucosa around the tympanic ostium of the eustachian tube of patients with EOM. In the animal model, strong immunoreactivity for TSLP was also observed in the eustachian tube epithelium, and mRNA expression of TSLP in the seven-day stimulated animals was significantly higher than that in the controls. CONCLUSION The present study indicates that the presence of epithelium-derived TSLP in the eustachian tubes plays an important role in the onset of EOM.
Collapse
Affiliation(s)
- Tomoya Miura
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naomi Kudo
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryutaro Hara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junko Takahata
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akira Sasaki
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
15
|
Animal models of acute otitis media - A review with practical implications for laboratory research. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:183-190. [PMID: 29656888 DOI: 10.1016/j.anorl.2017.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 11/23/2022]
Abstract
Considerable animal research has focused on developing new strategies for the prevention and treatment of acute otitis media (AOM). Several experimental models of AOM have thus been developed. A PubMed search of the English literature was conducted from 1975 to July 2016 using the search terms "animal model" and "otitis media" from which 91 published studies were included for analysis, yielding 123 animal models. The rat, mouse and chinchilla are the preferred animals for experimental AOM models with their individual advantages and disadvantages. The most common pathogens used to create AOM are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Streptococcus pneumoniae (types 3, 23 and 6A) and non-typeable Haemophilus influenzae (NTHi) are best options for inoculation into rat and mouse models. Adding viral pathogens such as RSV and Influenza A virus, along with creating ET dysfunction, are useful adjuncts in animal models of AOM. Antibiotic prophylaxis may interfere with the inflammatory response without a significant reduction in animal mortality.
Collapse
|
16
|
Ueki S, Ohta N, Takeda M, Konno Y, Hirokawa M. Eosinophilic Otitis Media: the Aftermath of Eosinophil Extracellular Trap Cell Death. Curr Allergy Asthma Rep 2017; 17:33. [PMID: 28455742 DOI: 10.1007/s11882-017-0702-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Eosinophilic otitis media (EOM) is a refractory disease characterized by the accumulation of eosinophils in middle ear effusion and mucosa. We summarize current knowledge regarding the clinical characteristics and management of EOM. Although eosinophil activation in inflamed foci is involved in the pathogenesis of EOM, little is known about the fate of the eosinophils and aftermath of their cell death. We discuss the possibility that eosinophils undergo non-apoptotic cell death that worsens tissue damage and increases effusion viscosity. RECENT FINDINGS Unlike chronic otitis media, EOM is strongly associated with an allergic background. Corticosteroids are currently the only effective pharmacological treatment, and surgical intervention is often required. Mucosal eosinophils infiltrate extensively into the middle ear cavity where they are stimulated by locally produced activators including interleukin-5 and eotaxin. The eosinophils undergo cytolysis in the effusion, which represents a major fate of activated eosinophils in vivo. Recent data revealed cytolysis could be renamed as extracellular trap cell death (ETosis). ETosis represents suicidal cell death involving total cell degranulation and development of sticky chromatin structures (extracellular traps (ETs)). The characteristics of eosinophil- and neutrophil-derived ET polymers might contribute to the difference in viscosity of secretions between EOM and common chronic otitis media. The extracellular products remaining after eosinophil ETosis are an important aspect of EOM pathology. The concept of ETosis also has novel implications for potential therapeutic modalities in various eosinophilic disorders.
Collapse
Affiliation(s)
- Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan.
| | - Nobuo Ohta
- Department of Otolaryngology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masahide Takeda
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
| | - Yasunori Konno
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
- Department of Dentistry and Oral Surgery, Akita University Hospital, Akita, Japan
| | - Makoto Hirokawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan
| |
Collapse
|
17
|
Kudo N, Matsubara A, Nishizawa H, Miura T. Immunohistological analysis of eotaxin and RANTES in the model animal of eosinophilic otitis media. Acta Otolaryngol 2017; 137:476-481. [PMID: 27981870 DOI: 10.1080/00016489.2016.1266508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The most crucial clinical problem of Eosinophilic Otitis Media (EOM) is sensorineural hearing loss. A previous report revealed that repeated antigen stimulation of middle ear causes eosinophilic inflammation not only in the middle ear but also in the inner ear. OBJECTIVE The purpose of the present study was to elucidate the mechanism of eosinophil infiltration to the inner ear in the animal model of EOM. METHODS Continuous OVA stimulation to the middle ear of guinea pigs was performed for 7 days, 14 days, and 28 days. Histological observation was made for eosinophil infiltration and morphological change of the inner ear. Immunostaining for eotaxin and RANTES was performed to study immunoreactivity of those chemokines. RESULTS In the 7-day stimulation side, a few eosinophils were found in the scala tympani, without obvious morphological damage of the inner ear. Moreover, immunoreactivity of both eotaxin and RANTES was significantly higher in the OVA stimulation sides than control sides. For both eotaxin and RANTES, the number of immunopositive cells was significantly increased in the 14-day stimulation side over the 7-day stimulation side. CONCLUSIONS Eotaxin and RANTES seem to play some important roles for the eosinophil infiltration in the middle and inner ear of model animal of EOM.
Collapse
Affiliation(s)
- Naomi Kudo
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hisanori Nishizawa
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoya Miura
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
18
|
Neff BA, Voss SG, Carlson ML, O'Brien EK, Butterfield JH. Treatment of eosinophilic otitis media with pegylated interferon-α 2a and 2b. Laryngoscope 2016; 127:1208-1216. [PMID: 27667784 DOI: 10.1002/lary.26303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/25/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE/HYPOTHESIS Eosinophilic otitis media (EOM) is a variant of chronic otitis media that is characterized by the development of thick mucoid middle ear effusion, adult onset bronchial asthma, sinonasal polyposis, and aspirin sensitivity. EOM is typically refractory to corticosteroid therapy and surgical intervention. Pegylated interferon (PEG-IFN) has effectively treated hypereosinophilic syndrome in clinical trials; however, the efficacy of this medication for EOM treatment remains undefined. STUDY DESIGN Retrospective, case series, tertiary academic center. METHODS A retrospective chart review was performed on EOM patients from 2008-2014. A total of 32 patients met the clinical criteria for EOM according to established diagnostic guidelines. Outcomes of all patients with severe, refractory EOM who initiated PEG-IFN therapy are reported. RESULTS Eight patients were treated with pegylated interferon-α 2a or 2b for refractory EOM. Half of the patients had significant side effects with interferon treatment. Three of these were able to continue at a reduced dosage without side effect reoccurrence, and one patient stopped the medication permanently. Four of eight (50%) patients had a complete clinical response with total resolution of otorrhea and normalization of middle ear mucosa, and were able to discontinue corticosteroid treatment. Two patients attempted to stop PEG-IFN therapy after prolonged symptom remission and had recurrent otorrhea. Both patients had symptom resolution after PEG-IFN reinitiation. CONCLUSIONS These data demonstrate that pegylated interferon-α 2a and 2b therapy may benefit patients with severe, refractory EOM. Further larger studies with long-term follow-up are required to validate these early but promising results. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1208-1216, 2017.
Collapse
Affiliation(s)
- Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Stephen G Voss
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| | - Joseph H Butterfield
- Department of Allergy and Immunology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.,Mayo Clinic Program for Mast Cell and Eosinophil Disorders, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A
| |
Collapse
|
19
|
Kanazawa H, Yoshida N, Iino Y. New Insights into Eosinophilic Otitis Media. Curr Allergy Asthma Rep 2016; 15:76. [PMID: 26546407 DOI: 10.1007/s11882-015-0577-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Eosinophilic otitis media (EOM) is a type of intractable otitis media that occurs mainly in patients with bronchial asthma (BA). In 2011, the diagnostic criteria for EOM were established. EOM is characterized by the presence of a highly viscous yellowish effusion containing eosinophils and immunoglobulin E (IgE), eosinophil chemoattractants, such as eosinophil cationic protein, interleukin-5, and eotaxin. Local sensitization against foreign agents such as fungi or bacteria (e.g., Staphylococcus aureus) may result in local IgE production in the middle ear and may be responsible for the severity of EOM. The clinical features of EOM closely resemble localized eosinophilic granulomatosis polyangiitis, therefore it is necessary to be vigilant to the symptoms of mononeuritis, polyneuritis, and skin purpura during diagnosis. Standard treatment for EOM is the instillation of triamcinolone acetonide into the mesotympanum. However, severe cases exhibiting strong inflammation and otorrhea are not easily controlled with antibiotics and/or corticosteroids. We proposed the introduction of a severity score to evaluate the severity of EOM. This score correlated with local IgE levels in middle ear effusion. Clinically, the risk factors associated with this severity score were body mass index, and the duration of bronchial asthma (from the onset of BA to the age of the first consultation of otitis media to our hospital). We emphasize that early diagnosis and adequate treatment are vital in preventing progressive and sudden hearing loss resulting from EOM.
Collapse
Affiliation(s)
- Hiromi Kanazawa
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
| | - Naohiro Yoshida
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
| | - Yukiko Iino
- Department of Otolaryngology, Tokyo-Kita Medical Center, Tokyo, Japan.
| |
Collapse
|
20
|
Sun W, Wang W. Advances in research on labyrinth membranous barriers. J Otol 2015; 10:99-104. [PMID: 29937790 PMCID: PMC6002577 DOI: 10.1016/j.joto.2015.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022] Open
Abstract
Integrity of the membranous labyrinth barrier system is of critical importance, which promotes inner ear homeostasis and maintains its features. The membranous labyrinth barrier system is divided into several subsets of barriers which, although independent from each other, are interrelated. The same substance may demonstrate different permeability characteristics through different barriers and under different conditions, while different substances can have different permeability features even in the same barrier under the same condition. All parts of the membranous labyrinth barrier structure, including their morphology, enzymes and channel proteins, and theirs permeability characteristics under various physiological and pathological conditions are reviewed in this paper. Infections, noise exposure, ototoxicity may all increase permeability of the barriers and lead to disturbances in inner ear homeostasis.
Collapse
Affiliation(s)
- Wenfang Sun
- Department of Otolaryngology, Fudan University Eye Ear Nose & Throat Hospital, 83 Fenyang Rd, Shanghai, 200031, PR China
| | - Wuqing Wang
- Department of Otolaryngology, Fudan University Eye Ear Nose & Throat Hospital, 83 Fenyang Rd, Shanghai, 200031, PR China
| |
Collapse
|
21
|
Ohta N, Ishida A, Kurakami K, Suzuki Y, Kakehata S, Ono J, Ikeda H, Okubo K, Izuhara K. Expressions and roles of periostin in otolaryngological diseases. Allergol Int 2014; 63:171-80. [PMID: 24759558 DOI: 10.2332/allergolint.13-rai-0673] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Indexed: 02/05/2023] Open
Abstract
Periostin is a 90-kDa member of the fasciclin-containing family; it functions as part of matricellular proteins, and its production by airway epithelial cells is induced by IL-4 and IL-13. Periostin is secreted by fibroblasts and upregulated in the airway epithelia of patients with bronchial asthma; it is considered to contribute to remodeling under this pathological condition. However, despite many studies in diverse research areas, our overall understanding of this intriguing molecule is still inadequate. Here, we integrate the available evidence on periostin expression and its roles in otolaryngological diseases, including allergic rhinitis, chronic rhinosinusitis with nasal polyps, aspirin-induced asthma, organized hematoma, eosinophilic otitis media, and IgG4-related disease. Periostin might be involved as an important structural mediator in pathological processes such as insult and injury, Th2-driven inflammation, extracellular matrix restructuring, fibrosclerosis, tumor angiogenesis, and tissue remodeling.
Collapse
Affiliation(s)
- Nobuo Ohta
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Akihiro Ishida
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kazuya Kurakami
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yusuke Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Junya Ono
- Shino-Test Corporation, Kanagawa, Japan
| | - Hiroki Ikeda
- Department of Otolaryngology, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Kimihiro Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Faculty of Medicine, Saga Medical School, Saga, Japan
| |
Collapse
|