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Oka A, Takahashi M, Nishimura W, Oyamada S, Oka S, Iwasaki S, Kanai K, Okano M. Gene expression of cytokines and prostaglandin metabolism-related proteins in eosinophilic otitis media. J Allergy Clin Immunol Glob 2024; 3:100237. [PMID: 38524784 PMCID: PMC10959659 DOI: 10.1016/j.jacig.2024.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 03/26/2024]
Abstract
The objective of this study was to investigate the levels of gene expression in the middle ear mucosa of 2 patients diagnosed with eosinophilic otitis media. One patient with severe hearing loss showed high expression levels of genes encoding IL-5 and IL-33 receptors.
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Affiliation(s)
- Aiko Oka
- Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Wataru Nishimura
- Department of Molecular Biology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Shogo Oyamada
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shinichiro Oka
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Satoshi Iwasaki
- Department of Otorhinolaryngology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Kengo Kanai
- Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Mitsuhiro Okano
- Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan
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Ishigaki K, Ikeda R, Kobayashi Y, Shirakura M, Koizumi S, Yoshida T, Suzuki J, Shiga K, Kawase T, Katori Y. Management of cholesterol granuloma due to eosinophilic otitis media using large ventilation tube. Auris Nasus Larynx 2023; 50:960-963. [PMID: 36792400 DOI: 10.1016/j.anl.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
A 46-year-old man who had been diagnosed with eosinophilic otitis media (EOM) and eosinophilic chronic rhinosinusitis was referred to our department. He suffered from bilateral earache, clogged ear sensation, and otorrhea associated with EOM. He had been treated with a myringotomy and a ventilation tube (VT) insertion. However, his symptoms did not improve, and the VT repeatedly fell out. We performed canal wall down mastoidectomy via a retro-auricular incision to remove the presumed cholesterol granuloma (CG) and a long-term VT insertion. The VT fell out repeatedly. Therefore, a large VT that Komune devised was inserted. Four months after reinsertion, there was no evidence of recurrent otorrhea or fallout of a large VT. A large VT insertion could be useful in the severe case of EOM with CG.
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Affiliation(s)
- Kento Ishigaki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan.
| | - Yuta Kobayashi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Shirakura
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shotaro Koizumi
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Yoshida
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyoto Shiga
- Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology and Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Nakashima D, Nakayama T, Minagawa S, Adachi T, Mitsuyama C, Shida Y, Nakajima T, Haruna SI, Matsuwaki Y. Dupilumab improves eosinophilic otitis media associated with eosinophilic chronic rhinosinusitis. Allergol Int 2023; 72:557-563. [PMID: 37061391 DOI: 10.1016/j.alit.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Eosinophilic otitis media (EOM) is a refractory condition associated with eosinophilic chronic rhinosinusitis and bronchial asthma. EOM is characterized by type-2 inflammation and is refractory to various treatments. We investigated the efficacy of dupilumab, interleukin-4 receptor alpha antagonist, for patients with EOM complicated by eosinophilic chronic rhinosinusitis (ECRS). METHODS Between April 2017 and April 2022, we treated 124 patients with dupilumab for refractory CRS or bronchial asthma. Of these, 14 had EOM concurrently, and 10 of them who had been treated for >6 months were included in our study. We retrospectively evaluated the efficacy of dupilumab by the amount of systemic corticosteroid used, the frequency of exacerbations, severity score of EOM, computed tomography (CT) score of temporal bones, and pure tone audiometry. We also enrolled 8 EOM patients without dupilumab treatment as a control group. RESULTS Dupilumab significantly improved the amount of systemic corticosteroid used and the frequency of exacerbation and compared with before dupilumab was used (p = 0.01 and <0.01, respectively). All patients could be weaned from systemic-corticosteroid therapy by 54 weeks of dupilumab use. The severity score of EOM and CT score for temporal bones were significantly lower than before the treatment (p = 0.01 and 0.01, respectively). Compared to the control group, the systemic corticosteroid used and severity scores were improved in the dupilumab group (p = 0.02 and < 0.01, respectively). CONCLUSIONS Dupilumab could be used to wean patients from systemic corticosteroids with the improvement of severity score in EOM associated with ECRS and bronchial asthma.
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Affiliation(s)
- Daiki Nakashima
- Matsuwaki Clinic Shinagawa, Tokyo, Japan; Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tsuguhisa Nakayama
- Matsuwaki Clinic Shinagawa, Tokyo, Japan; Department of Otorhinolaryngology and Head & Neck Surgery, Dokkyo Medical University, Tochigi, Japan.
| | - Syunsuke Minagawa
- Matsuwaki Clinic Shinagawa, Tokyo, Japan; Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Adachi
- Matsuwaki Clinic Shinagawa, Tokyo, Japan; Musashino Allergy Clinic, Tokyo, Japan
| | | | - Yoko Shida
- Matsuwaki Clinic Shinagawa, Tokyo, Japan
| | | | - Shin-Ichi Haruna
- Matsuwaki Clinic Shinagawa, Tokyo, Japan; Department of Otorhinolaryngology and Head & Neck Surgery, Dokkyo Medical University, Tochigi, Japan
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Sato E, Seo Y, Tagaya E, Yagi O, Yamamura Y, Nonaka M. Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone. Int Arch Allergy Immunol 2023; 184:1116-1125. [PMID: 37619543 DOI: 10.1159/000531980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/09/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Eosinophilic otitis media (EOM) is well-known to frequently co-exist with adult-onset asthma. Both diseases are similar type 2 inflammation and are considered to have a "one airway, one disease" relationship. Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO), characterized by airway obstruction caused by airway wall thickening (AWT), is a severe condition with a higher incidence of mortality compared to asthma alone or COPD alone. Based on the "one airway, one disease" concept, we hypothesized that the inflammatory pathophysiology of EOM differs depending on its comorbidity with ACO or with asthma alone. METHODS A total of 77 chronic rhinosinusitis (CRS) patients with asthma were enrolled in this study. The subjects were divided into 2 groups: a group with comorbid asthma alone (asthma group; 46 patients), and a group with comorbid ACO (ACO group; 31 patients). The 2 groups were compared and assessed with regard to various factors, including the patients' clinical characteristics, prevalence rate of EOM, EOM severity, EOMs relationships with smoking and AWT, and the eosinophil and neutrophil cell counts in the middle ear effusion (MEE). RESULTS The ACO group included significantly more males (p < 0.05), was significantly older (p < 0.05), and showed significantly lower lung function values (FEV1 [L], FEV1 [%pred]) (p < 0.01) compared with the asthma group. The ACO group also had a significant history of smoking as shown by the Brinkman index (p < 0.01) and greater AWT as assessed by high-resolution computed tomography (p < 0.05). The EOM prevalence rate was significantly higher in the ACO group (p < 0.05), especially with increased ACO severity (p < 0.05). The EOM severity was also significantly higher in the ACO group (p < 0.05) and also correlated with the ACO severity (p < 0.05). The pretreatment ear clinical characteristics score and the average air conduction hearing level were significantly higher in the ACO group (p < 0.05). The eosinophil percentage in the MEE/otorrhea was significantly lower in the ACO group (25.3%) than in the asthma group (54.7%) (p < 0.05). Conversely, the neutrophil percentage was significantly higher in the ACO group (75.7% vs. 41.9%) (p < 0.05). CONCLUSIONS Our findings suggest that, in CRS patients with asthma, comorbidity with ACO may be a clinical factor leading to increased EOM prevalence and severity, as well as a higher neutrophil infiltration percentage in the middle ear. Cessation of smoking and early therapeutic intervention for ACO may mitigate progression of bronchial remodeling (i.e., reduce AWT) and help reduce the prevalence and severity of EOM.
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Affiliation(s)
- Emiri Sato
- Department of Otorhinolaryngology, Tokyo Women's Medical University, Tokyo, Japan,
| | - Yukako Seo
- Department of Otorhinolaryngology, Tokyo Women's Medical University, Tokyo, Japan
| | - Etsuko Tagaya
- First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Osamitsu Yagi
- First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yukie Yamamura
- Department of Otorhinolaryngology, Tokyo Women's Medical University, Tokyo, Japan
| | - Manabu Nonaka
- Department of Otorhinolaryngology, Tokyo Women's Medical University, Tokyo, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Naohiro Yoshida
- Department of Otolaryngology- Head and Neck Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
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Takeshita Y, Tada Y, Okano M, To M, To Y. Dupilumab Remarkably Improved Eustachian Tube Obstruction: A Case of Mepolizumab-Resistant Eosinophilic Otitis Media. J Investig Allergol Clin Immunol 2023; 33:57-58. [PMID: 35234642 DOI: 10.18176/jiaci.0803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Y Takeshita
- Department of Pulmonary Medicine, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - Y Tada
- Department of Pulmonary Medicine, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - M Okano
- Department of Otorhinolaryngology, International University of Health and Welfare, Chiba, Japan
| | - M To
- Department of Laboratory Medicine, Dokkyo Medical University, Saitama Medical Center, Koshigaya City, Saitama, Japan
| | - Y To
- Department of Pulmonary Medicine, International University of Health and Welfare, Atami Hospital, Shizuoka, Japan
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Kang N, Shin J, Cho YS, Lee JY, Lee BJ, Choi DC. Intractable middle ear effusion in EGPA patients might cause permanent hearing loss: a case-control study. Allergy Asthma Clin Immunol 2022; 18:68. [PMID: 35933390 DOI: 10.1186/s13223-022-00706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Background Ear, nose, and throat involvement are common in eosinophilic granulomatosis with polyangiitis (EGPA). Among otologic manifestation, middle ear effusion (MEE) is less recognized but a problematic condition as it may progress to hearing impairment when left untreated. This study aimed to evaluate the characteristics, risk factors and clinical outcomes of MEE in EGPA patients. Methods This is a case–control study of patients who were diagnosed and treated for EGPA from January 1995 to November 2018. Patients with ear symptoms (ear fullness, ear discharge, tinnitus or hearing loss) were assessed by otologists and were included in the case group (n = 23) if clinically relevant. The other patients without MEE were included in the control group (n = 52). Risk of MEE was calculated using the Cox proportional-hazard model. Results During median follow-up of 9.9 years, 23 (30.7%) out of 75 patients had MEE. In MEE group, 12 (52.2%) patients had hearing loss; conductive type in 10 (10/12, 83.3%) and mixed type in two (2/12, 16.7%). In multivariable regression analysis, major organ involvement at diagnosis (adjusted hazard ratio [aHR] 65.4; 95% confidence interval [CI], 1.50—2838.39; P = 0.030] , early onset of ear symptom after systemic therapy (< 6 months) (aHR 40.0; 95% CI, 1.35—1183.43; P = 0.033) and continuing the maintenance steroid without cessation (aHR 8.59; 95% CI, 1.13—65.42; P = 0.038) were independently associated with a risk of MEE. To control MEE, 16 (69.6%) patients had to increase maintenance steroid dose and 9 (39.1%) patients experienced recurrent MEE whenever maintenance dose was tapered. Conclusions MEE is a common but frequently neglected condition in EGPA which is often intractable. The maintenance steroid dose should be adequately adjusted to control MEE and to prevent from progressive hearing loss. Novel biologic agents possibly have a role in controlling MEE in EGPA.
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Ohira S, Komori M, Matsui H, Furuya H, Kajiwara R, Matsuura K, Wada K. Anatomical Features Around Eustachian Tube in Eosinophilic Otitis Media With Eosinophilic Sinusitis. Laryngoscope 2021; 131:E2689-E2695. [PMID: 34060671 DOI: 10.1002/lary.29671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/26/2021] [Accepted: 05/16/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study investigated the relationships between anatomical findings around the eustachian tube (ET) and eosinophilic otitis media (EOM) accompanied by eosinophilic chronic rhinosinusitis (ECRS). STUDY DESIGN This study employed axial, coronal, sagittal and oblique computed tomography. METHODS Patients who underwent endoscopic sinus surgery at the Department of Otolaryngology, Toho University Medical Center Omori Hospital and were diagnosed with ECRS (106 patients) based on the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis study were included. Subsequently, the presence of EOM accompanied by ECRS in 212 ear sides was assessed, and preoperative sinus computed tomography was used to evaluate various anatomical findings, such as the development of the sphenoid sinus and mastoid cells at the apex of petrous bone, the angle and length of the ET, and the size of the tympanic orifice of the ET. The relationships between these anatomical findings and the presence of EOM were analyzed statistically. RESULTS EOM accompanied by ECRS was associated with a high peripheral blood eosinophil count and bronchial asthma. Among anatomical factors, the absence of peri-ET cells or petrous apex cells, and a low angle and short length of the ET, were risk factors for the onset of EOM. CONCLUSION Anatomical factors such as the absence of peri-eustachian cells or petrous apex cells, and low angle or short length of the ET, are risk factors for the onset of EOM along with ECRS. Assessment of these factors may help in preventing the future onset or aggravation of EOM. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2689-E2695, 2021.
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Affiliation(s)
- Shinya Ohira
- Department of Otorhinolaryngology, Omori Medical Center, Toho University, Tokyo, Japan
| | - Manabu Komori
- Department of Otorhinolaryngology, St. Marianna University, Kawasaki, Japan
| | - Hidehito Matsui
- Department of Otorhinolaryngology, Omori Medical Center, Toho University, Tokyo, Japan
| | - Hanae Furuya
- Department of Otorhinolaryngology, Omori Medical Center, Toho University, Tokyo, Japan
| | - Riko Kajiwara
- Department of Otorhinolaryngology, Omori Medical Center, Toho University, Tokyo, Japan
| | - Kentaro Matsuura
- Department of Otorhinolaryngology, Omori Medical Center, Toho University, Tokyo, Japan
| | - Kota Wada
- Department of Otorhinolaryngology, Omori Medical Center, Toho University, Tokyo, Japan
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Takahashi M, Oka A, Kariya S, Gion Y, Sato Y, Iwasaki S, Oyamada S, Matsubara A, Okano M. IgG4 Expression in Patients with Eosinophilic Otitis Media. ORL J Otorhinolaryngol Relat Spec 2021; 83:167-171. [PMID: 33691317 DOI: 10.1159/000512726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Eosinophilic otitis media (EOM) is an intractable middle ear disease recognized by an eosinophil enriched middle ear effusion and mucosa. Although precise pathogenesis of EOM remains unclear, it is characterized by type 2 inflammation. Since IgG4 is an IgG subclass induced by type 2 cytokines such as IL-4 and IL-13, we sought to characterize and compare local IgG4 expression in patients with and without EOM. METHODS Twelve patients with bilateral profound hearing loss, 9 of which underwent a cochlear implant surgery, were enrolled in this study (6 with EOM and 6 without EOM). The surgical specimens were harvested during surgery and were subjected to IgG4 immunostaining. RESULT The middle ear mucosa showed the presence of a large number of IgG4-positive cells in patients with EOM, which was significantly higher than that in patients without EOM. CONCLUSION Local IgG4 expression was observed in patients with EOM in comparison to those without EOM, suggesting that IgG4 contributes to EOM pathogenesis.
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Affiliation(s)
- Masahiro Takahashi
- Department of Otorhinolaryngology, Mita Hospital, International University Health and Welfare, Tokyo, Japan,
| | - Aiko Oka
- Department of Otorhinolaryngology, School of Medicine, International University Health and Welfare, Narita, Japan
| | - Shin Kariya
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuka Gion
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Satoshi Iwasaki
- Department of Otorhinolaryngology, Mita Hospital, International University Health and Welfare, Tokyo, Japan
| | - Shogo Oyamada
- Department of Otorhinolaryngology, Mita Hospital, International University Health and Welfare, Tokyo, Japan
| | - Atsushi Matsubara
- Department of Otolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Mitsuhiro Okano
- Department of Otorhinolaryngology, School of Medicine, International University Health and Welfare, Narita, Japan
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Shimizu H, Kato H, Yoshioka S, Okazawa M. Rapid and remarkable effectiveness of benralizumab for treating severe bronchial asthma with intractable eosinophilic rhinosinusitis and eosinophilic otitis media: A case report. Respir Med Case Rep 2020; 32:101336. [PMID: 33489745 PMCID: PMC7809429 DOI: 10.1016/j.rmcr.2020.101336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/08/2020] [Accepted: 12/26/2020] [Indexed: 12/14/2022] Open
Abstract
Severe bronchial asthma is a challenging disorder to treat and can impair quality of life (QOL) under conventional therapeutic modalities. We report the case of a 52-year-old woman with severe asthma associated with eosinophilic chronic rhinosinusitis (ECRS) and eosinophilic otitis media (EOM). Although the patient was treated with a full dose of inhaled corticosteroid, leukotriene receptor antagonist (LTRA), theophylline, burst use of oral corticosteroids (OCS), her asthmatic condition aggravated, disrupting her daily life. ECRS and EOM symptoms were also getting worse despite treatment with topical application of corticosteroids to the nose and ears, LTRA, and occasional use of OCS. In addition to asthmatic symptom, the patient always suffered from intractable nasal obstruction and hearing disturbance, which contributed to the heavily impaired QOL. However, the administration of benralizumab showed rapid and remarkable improvement not only in her asthmatic conditions but also in the symptoms of ECRS and EOM within a month. These results suggest that the use of benralizumab for the treatment of severe asthma with intractable ECRS and EOM should be considered when the patient's QOL is severely deteriorated.
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Key Words
- ADL, activity of daily living
- AR, allergic rhinitis
- BMI, body mass index
- Benralizumab
- CT, computed tomography
- ECRS, eosinophilic chronic rhinosinusitis
- EOM, eosinophilic otitis media
- Eosinophilic chronic rhinosinusitis
- Eosinophilic otitis media
- FeNO, Fractional exhaled nitric oxide
- JESREC, Japanese epidemiological survey of refractory eosinophilic rhinosinusitis
- LTRA, leukotriene receptor antagonist
- OCS, oral corticosteroids
- QOL
- QOL, quality of life
- SMART, single maintenance and reliever therapy
- Severe asthma
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Affiliation(s)
- Hideyasu Shimizu
- Toshiwakai Clinic, Nagoya Japan, Nagoya, Japan.,Department of Medicine, Division of Respiratory Medicine and Clinical Allergy, Fujita Health University, Toyoake, Japan
| | - Hisayuki Kato
- Department of Otolaryngology-Head and Neck Surgery, Fujita Health University, Toyoake, Japan
| | - Satoshi Yoshioka
- Department of Otolaryngology-Head and Neck Surgery, Fujita Health University, Toyoake, Japan
| | - Mitsushi Okazawa
- Department of Medicine, Division of Respiratory Medicine and Clinical Allergy, Fujita Health University, Toyoake, Japan.,Department of Respiratory Medicine, Daiyukai General Hospital, Daiyukai Health System, Ichinomiya, Japan
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Yang J, Zhao C, Chen P, Zhao S. Morphological and pathological changes of Eustachian tube mucosa in an animal model of eosinophilic otitis media. Braz J Otorhinolaryngol 2020; 88:701-707. [PMID: 33176987 PMCID: PMC9483936 DOI: 10.1016/j.bjorl.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/06/2020] [Accepted: 09/10/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Eosinophilic otitis media is an intractable otitis media and a fairly common middle ear disease. However, the pathogenesis of eosinophilic otitis media is obscure. OBJECTIVE To observe the pathological and ultrastructural changes of the Eustachian tube mucosal epithelium in rats with eosinophilic otitis media and further explore the pathogenesis of eosinophilic otitis media. METHODS Animals were intraperitoneally injected with 2000 mg ovalbumin and 100 mg aluminum hydroxide (alum) on day 0, followed by 100 mg ovalbumin and 100 mg alum injection on days 7 and 14. Next they were topically boosted by daily application of 100 mg ovalbumin solution via nasal drip and intratympanic injection of 0.1 mL ovalbumin (1000 mg/mL) in the right ear (group A, n = 80) and 0.1 mL saline in the left ear as control (group B, n = 80) starting on day 21 and continuing for 14 days. The temporal bones were dissected on the 35th, 38th, 41st and 43rd day separately under anesthesia. Scanning electron microscopy, hematoxylin-eosin and toluidine blue staining were used to observe the pathological and morphological changes of Eustachian tube mucosa stained samples. Moreover, inflammatory cells and cilia were counted. RESULTS The epithelium of the Eustachian tube in group A was swollen and thickened. The cilia were arranged in a disorderly manner and partially detached. Eosinophils infiltrated the submucosal layer of the Eustachian tube, and their number increased significantly compared with that in group B (p < 0.05). Simultaneously, mast cell degranulation was observed in group A. Scanning electron microscopy revealed that the cilia were lodged and gathered along the whole length of Eustachian tube in group A. Ciliated cell density was significantly lower than that in Group B (p < 0.01). CONCLUSION In the eosinophilic otitis media model, allergy caused significant changes in pathology and morphology of the Eustachian tube mucosa, affecting the normal function of the Eustachian tube which played an important role in the occurrence and development of eosinophilic otitis media.
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Affiliation(s)
- Jinsong Yang
- Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Department of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Chunli Zhao
- Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Department of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Peiwei Chen
- Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Department of Otolaryngology Head and Neck Surgery, Beijing, China
| | - Shouqin Zhao
- Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Department of Otolaryngology Head and Neck Surgery, Beijing, China.
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Iino Y, Sekine Y, Yoshida S, Kikuchi S. Dupilumab therapy for patients with refractory eosinophilic otitis media associated with bronchial asthma. Auris Nasus Larynx 2020; 48:353-360. [PMID: 32943257 DOI: 10.1016/j.anl.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/09/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Eosinophilic otitis media (EOM) is an intractable otitis media mostly associated with bronchial asthma. Dupilumab, an anti-interleukin (IL)-4 receptor (R)α, is effective and has been approved for use in patients with moderate to severe bronchial asthma, atopic dermatitis and chronic rhinosinusitis with nasal polyposis, whose diseases are not controlled by previous treatments including other molecular targeted drugs. We aimed to assess efficacy of dupilumab in three EOM patients with associated bronchial asthma, who were poor responders to previous topical and systemic corticosteroid therapy and molecular targeted therapies. PATIENTS AND METHODS Three patients with severe, refractory EOM (two with a granulation type) associated with bronchial asthma received dupilumab as add-on therapy for at least 6 months. The efficacy of dupilumab therapy was evaluated using severity scores, symptom scores, hearing acuities, temporal bone computed tomography (CT) scores, and surrogate markers before and after therapy. RESULTS Severity scores in all patients were dramatically reduced to 2 points or less (full score: 16 points) after initiation of therapy. Air conduction hearing levels were improved in all patients. Temporal bone CT scores in two patients were reduced, and serum IgE levels in all three patients also decreased following therapy. CONCLUSION We provide the first report that add-on dupilumab therapy was effective in patients with severe, refractory EOM who did not respond to the treatments including other molecular targeted therapy. Patients with severe middle ear mucosal change may benefit particularly from dupilumab therapy.
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Affiliation(s)
- Yukiko Iino
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan.
| | - Yasuhiro Sekine
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saeko Yoshida
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saori Kikuchi
- Department of Otolaryngology, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
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Masuda M, Esu Y, Iino Y, Yoshida N. Risk factors for bacterial infection to cause sensorineural hearing loss in eosinophilic otitis media. Auris Nasus Larynx 2021; 48:207-13. [PMID: 32883575 DOI: 10.1016/j.anl.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Eosinophilic otitis media (EOM) is an intractable type of otitis media in which sensorineural hearing loss (SNHL) progresses over time. Clinically, bacterial infection complicates the course of EOM, making it challenging to control otorrhea/middle ear effusion (MEE) from infected ears, and accelerates the progression of SNHL. In this study, we focused on infection, one of the risk factors for SNHL in EOM, and analyzed factors associated with it. METHODS In this cohort study, we evaluated 144 ears of 72 patients diagnosed with bilateral EOM. Patients visited our hospital once every 1-3 months and received intratympanic or systematic administration of steroids when otorrhea/MEE was observed. Several investigations, including blood tests, otorrhea/MEE cytology, bacterial culture tests, and respiratory function tests, were performed. In the otorrhea/MEE cytology, the leukocyte fraction was measured. RESULTS Two risk factors for SNHL in EOM were middle ear mucosal thickening (p <0.01) and infection (p <0.05). Compared to the group with <40% neutrophils in otorrhea/MEE samples, groups with 40-70% and ≥70% neutrophils had a significantly higher bone conduction hearing level (p <0.01, p <0.05, respectively). Two risk factors associated with the occurrence of infection in EOM were tympanic membrane (TM) perforation (p <0.01) and the coincidence of otorrhea/MEE and rhinorrhea in bacterial culture test results (p <0.001). A positive correlation was observed between TM perforation and infection (p <0.001). Our analysis of the relationship between the frequency of intratympanic corticosteroids administration and the time-period until the occurrence of TM perforation showed that >4 intratympanic administrations/year significantly increased the risk of perforation (p<0.001). Pseudomonas aeruginosa was isolated from otorrhea/MEE samples, while Pseudomonas aeruginosa and fungi, detected in cultures of rhinorrhea samples, were significantly related to the deterioration of bone conduction hearing levels. CONCLUSION The risk factors associated with the occurrence of infection in patients with EOM were TM perforation and the coincidence of otorrhea/MEE and rhinorrhea in bacterial culture test results. Since TM perforation is likely to occur even due to intratympanic corticosteroids administration, it is necessary to confirm whether the frequency of treatment is appropriate and try a less invasive technique of administration. Furthermore, Pseudomonas aeruginosa infection poses a high risk for the development of SNHL, and clinicians should be alert to this possibility, even if the bacteria were identified only in cultures of rhinorrhea samples.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Esu Y, Masuda M, Yoshida N. Periostin in middle ear mucosa according to eosinophilic otitis media severity: Middle ear pathology-based treatment. Auris Nasus Larynx 2020; 47:527-535. [PMID: 32586742 DOI: 10.1016/j.anl.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/01/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Eosinophilic otitis media (EOM) is an intractable disorder associated with bronchial asthma and chronic rhinosinusitis with nasal polyposis. Periostin is an extracellular matrix protein secreted by fibroblasts in response to interleukin (IL)-4 and/or IL-13 and is a known marker for eosinophilic disorders. We assessed serum periostin levels and expression of periostin in the middle ear mucosa according to three grade of EOM severity (grade1 to 3). METHODS 68 patients of blood and serum samples were corrected by whom diagnose bilateral EOM in Jichi Medical University Saitama Medical Center from January 2015 to June 2017.Immunohistochemical evaluation was performed to 18 EOM middle ears mucosa samples, which cauterized in tree groups and compared to that of chronic otitis media (COM). RESULTS Serum periostin levels was significantly higher in EOM patients than in COM patients (EOM, 125.0 ± 45.5 ng/mL; COM, 79.4 ± 38.3 ng/mL; P<0.0001). The expression of periostin immunopositivity in the EOM middle ear mucosa was significantly greater in severe cases (grade3 samples) than others (grade1 and grade2 samples) (P <0.001 and P = 0.011, respectively). Periostin was expressed at the lamina propria especially in severe EOM cases and the cases had little response to glucocorticoids treatment. CONCLUSION This study showed that periostin in the middle ear mucosa was correlated with EOM severity, and EOM with highly expressed periostin had difficulty in glucocorticoids treatment.
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Affiliation(s)
- Yoshihiko Esu
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Saitama 330-8503, Japan
| | - Maria Masuda
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Saitama 330-8503, Japan
| | - Naohiro Yoshida
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Saitama 330-8503, Japan
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Kagoshima H, Hori R, Kojima T, Okanoue Y, Taguchi A, Yamamoto H, Hasebe K, Shoji K. Successful treatment of eosinophilic chronic rhinosinusitis and eosinophilic otitis media using the anti-IL-5 receptor monoclonal antibody benralizumab: A case report. Respir Med Case Rep 2020; 30:101135. [PMID: 32612919 PMCID: PMC7322358 DOI: 10.1016/j.rmcr.2020.101135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 01/21/2023] Open
Abstract
Eosinophilic chronic rhinosinusitis (ECRS) is characterized by the presence of nasal polyps, dominant ethmoid shadows in computed tomography (CT) scans, and elevated levels of eosinophil infiltration into the nasal polyps and peripheral blood. ECRS is often accompanied by severe asthma. The recent development of monoclonal antibody-based biologics, including benralizumab, has offered new therapeutic approaches for the treatment of asthma and allergic diseases. Asthma and ECRS are closely related; hence, benralizumab could provide clinical benefit in ECRS patients with severe asthma. Herein, we report a case of a 47-year-old female patient with severe asthma that presented with nasal obstruction and hearing impairment. Nasal endoscopic and otoscopic examinations indicated the presence of bilateral nasal polyps in the middle nasal meatus, as well as a bilateral effusion in the tympanic cavity. Sinus and temporal CT images showed dominant ethmoid sinus and tympanic cavity shadows. Biopsy of nasal polyps revealed high numbers of eosinophils, which led to the diagnosis of ECRS; eosinophilic otitis media (EOM) with hypereosinophilia was also suspected. Treatment with benralizumab reduced the number of peripheral blood eosinophils and improved asthma symptoms. Prolonged benralizumab administration also resulted in a remarkable size reduction in bilateral middle nasal polyps and aeration of the tympanic cavity. In conclusion, benralizumab treatment improved the symptoms of severe asthma, ECRS, and EOM. Eosinophil depletion could be an important mechanism by which benralizumab improves ECRS and EOM. The use of benralizumab for the treatment of ECRS and EOM patients with severe asthma merits further investigation in large-cohort studies.
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Affiliation(s)
- Hiroki Kagoshima
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryusuke Hori
- Department of Otolaryngology, Tenri Hospital, Nara, Japan
| | | | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, Nara, Japan
| | - Atsushi Taguchi
- Department of Otolaryngology-Head & Neck Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | | | - Koki Hasebe
- Department of Otolaryngology, Tenri Hospital, Nara, Japan
| | - Kazuhiko Shoji
- Department of Otolaryngology, Tenri Hospital, Nara, Japan
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Abstract
PURPOSE OF REVIEW To examine the relationship between otitis media, allergic rhinitis, and age. RECENT FINDINGS Otitis media and allergic rhinitis are prevalent conditions with a controversial relationship. Some data suggest that these entities are significantly associated, either through allergic rhinitis inducing Eustachian tube dysfunction or through allergic pathophysiology simultaneously occurring intranasally and in the ear. Other studies, however, have refuted this relationship. For example, treatment with antihistamines does not reliably improve OME, making causation and association challenging to establish. Age may have an effect on the nature of the relationship between allergic rhinitis and otitis media, by impacting both the individual conditions and their association. Epidemiological, immunological, and adenoidal studies have suggested that differences occur with age, and this review encapsulates the related data and publications. We begin by evaluating how allergic rhinitis and otitis media each are affected by age, then evaluate the role that age may have in the relationship between the two conditions. Adult and pediatric literature are evaluated so as to include the full impact of age across patients' lifespan. Age induces changes in immunity, patterns of inflammation, and susceptibility to both allergic rhinitis and otitis media with effusion. Age may also be an effect modifier which impacts the nature of the relationship between these two conditions. The influence of age on the association between these highly prevalent conditions remains a topic of active study.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Suzaki I, Kimura Y, Tanaka A, Hirano K, Ishibashi A, Mizuyoshi T, Ando I, Kitajima T, Watanabe S, Hinohira Y, Kobayashi H. Successful treatment of eosinophilic otitis media associated with severe bronchial asthma with an anti-IL-5 monoclonal antibody, mepolizumab. Auris Nasus Larynx 2018; 46:141-146. [PMID: 29909018 DOI: 10.1016/j.anl.2018.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
Abstract
Eosinophilic otitis media (EOM), which is characterized by the accumulation of eosinophils in middle ear effusion and the middle ear mucosa, is a refractory type of otitis media that is often associated with asthma. Although an early diagnosis and appropriate treatment are necessary to prevent the progression of hearing loss in patients with EOM, there are currently no well-established treatments for this condition. We treated a 60-year-old male patient with asthma and EOM. The patient's asthma was poorly controlled, despite the use of high-dose inhaled corticosteroids, long-acting beta-agonist treatment, and the regular use of systemic corticosteroids. Mepolizumab, an anti-IL-5 monoclonal antibody, was started to treat the patient's refractory asthma. At 4 months after the initiation of mepolizumab treatment, the patient's asthma, hearing, and middle ear effusion improved. The present case suggests that mepolizumab therapy can control EOM and asthma.
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Affiliation(s)
- Isao Suzaki
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan.
| | - Yurika Kimura
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan; Tokyo Metropolitan Health and Medical Treatment Corporation, Ebara Hospital, Tokyo, Japan
| | - Akihiko Tanaka
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University, School of Medicine, Tokyo, Japan
| | - Kojiro Hirano
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Atsushi Ishibashi
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Tomomi Mizuyoshi
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Izumi Ando
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Tatsuya Kitajima
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - So Watanabe
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan; Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yasuyuki Hinohira
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan; Kamio Memorial Hospital, Tokyo, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
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Abstract
OBJECTIVES (1) To assess the ability of flow cytometric immunophenotyping to detect and quantitate eosinophils in patients with eosinophilic otitis media (EOM). (2) to evaluate the association of EOM to bronchial asthma. METHODS Twenty-one patients with chronic otorrhea or middle ear effusion (MEE) were included in this prospective cohort study. Group I composed of 10 patients (14 ears) and associated to bronchial asthma. Group II included 11 patients (11 ears) without bronchial asthma. Samples of MEE were sent for flow cytometric analysis at initial presentation. Patients with positive eosinophils on flow cytometric immunophenotyping were analyzed after one-month course of dexamethasone eardrops. RESULTS EOM was diagnosed in all patients of group I and in three patients of group II. The mean eosinophils percentage was 43.5% and 14.2% for group I and group II, respectively (p = .006). Those patients showed a significant response to dexamethasone eardrops, both on clinical examination and on flow cytometric analysis with a decrease in eosinophil levels post-treatment. However, this improvement was temporary and symptoms recurred after treatment cessation. Bronchial asthma was not associated to all patients with EOM. CONCLUSION Diagnosis of EOM remained mostly clinical; flow cytometry immunophenotyping of MEE may be helpful as an additional tool in diagnosis and monitoring the response to treatment, particularly in non-asthmatic patients.
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Affiliation(s)
- Issam Saliba
- Division of Otolaryngology – Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC, Canada
| | - Musaed Alzahrani
- Division of Otolaryngology – Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC, Canada
| | - Xiaoduan Weng
- Department of Medicine, Division of Hematology and Medical Oncology, Montreal University Hospital Center, Montreal, QC, Canada
| | - Alain Bestavros
- Department of Medicine, Division of Hematology and Medical Oncology, Montreal University Hospital Center, Montreal, QC, Canada
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Seo Y, Nonaka M, Yamamura Y, Pawankar R, Tagaya E. Optimal control of asthma improved eosinophilic otitis media. Asia Pac Allergy 2018; 8:e5. [PMID: 29423372 PMCID: PMC5796965 DOI: 10.5415/apallergy.2018.8.e5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/21/2018] [Indexed: 12/05/2022] Open
Abstract
Background Eosinophilic 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. Objective We conducted a pilot study to determine whether appropriate strengthening of inhalation therapy for asthma is effective for EOM. Methods Fifteen 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. Results In 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. Conclusion In 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.
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Affiliation(s)
- Yukako Seo
- Department of Otolaryngology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Manabu Nonaka
- Department of Otolaryngology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yukie Yamamura
- Department of Otolaryngology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo 113-0022, Japan
| | - Etsuko Tagaya
- First Department of Medicine, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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22
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Abstract
Allergy is commonly associated with conditions such as rhinitis, sinusitis, and asthma, but the relationship between allergy and otologic diseases is less clear. This article examines the evidence for a relationship between allergic disease and several common otologic conditions, including otitis media with effusion, eosinophilic otitis media, and Ménière's disease.
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Affiliation(s)
- Betty Yang
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, 820 Harrison Avenue, FGH Building 4th Floor, Boston, MA 02118, USA
| | - Christopher D Brook
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, 820 Harrison Avenue, FGH Building 4th Floor, Boston, MA 02118, USA.
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23
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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.
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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
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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25
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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.
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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.
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26
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Uchimizu H, Matsuwaki Y, Kato M, Otori N, Kojima H. Eosinophil-derived neurotoxin, elastase, and cytokine profile in effusion from eosinophilic otitis media. Allergol Int 2015; 64 Suppl:S18-23. [PMID: 26344075 DOI: 10.1016/j.alit.2015.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/28/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Eosinophilic otitis media (EOM) is an intractable disease characterized by a remarkably viscous effusion and accumulation of numerous eosinophils in both the middle ear effusion and the mucosa. The key factors in EOM pathogenesis remain unclear. The purpose of this study is to identify the important factors involved in EOM pathogenesis. METHODS Middle ear effusion samples were collected from 12 patients with EOM and 9 patients with secretory otitis media (SOM), as controls. Multiple cytokines in the effusion were measured using a Bio-Plex™ Human Cytokine 27-Plex panel. Eosinophil-derived neurotoxin (EDN) and elastase were measured by ELISA. The concentrations of EDN, elastase, and each cytokine were compared between the EOM and SOM groups. Furthermore, in the EOM group, each cytokine was examined for correlation with EDN and elastase. RESULTS EDN and elastase concentrations were significantly higher in the EOM group than in the SOM group (p < 0.05). IL-5, IL-1β, MIP-1α, G-CSF, IL-1ra, IL-4, IFN-γ, MIP-1β, IL-10, TNF-α, VEGF, and IL-2 concentration was significantly higher in the EOM group than in the SOM group (p < 0.05). Significant positive correlations were found between EDN and IL-1ra, IL-2, IL-5, IL-9, IL-13, eotaxin, MIP-1α, PDGF-BB, and RANTES in the EOM group (p < 0.05). CONCLUSIONS Our study showed that IL-5, IL-2, MIP-1α, and IL-1ra are the important factors involved in EOM pathogenesis. Furthermore, not only eosinophil, but also neutrophil are involved in middle ear inflammation of EOM.
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27
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Kanazawa H, Yoshida N, Yamamoto H, Hara M, Hasegawa M, Matsuzawa S, Shinnabe A, Iino Y. Risk factors associated with severity of eosinophilic otitis media. Auris Nasus Larynx 2014; 41:513-7. [PMID: 25199747 DOI: 10.1016/j.anl.2014.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Eosinophilic otitis media (EOM) is an intractable otitis media associated with bronchial asthma. Clinical characteristics of EOM are apparent, but severe EOM, which is unresponsive to ongoing treatments, can occur. The present study aimed to investigate potential risk factors associated with the severity of EOM. METHODS We scored the EOM severity of 26 patients according to quantity of middle ear effusion (MEE), thickness of the middle ear mucosa, use of topical and oral corticosteroids, and use of antibiotics, all measured over a 3-month period. The scores for four 3-month periods (1 year) were averaged. We analyzed the prevalence of clinical variables by partial regression: sex, age, body mass index (BMI), duration of bronchial asthma, association of aspirin-intolerant asthma, Lund-Mackay score for sinusitis, mastoid pneumatization, width of the bony Eustachian tube at the tympanic orifice, percentage of eosinophils and immunoglobulin E in peripheral blood, and association of allergic rhinitis. Duration of bronchial asthma was defined as the period from onset of bronchial asthma to the age of first consultation at our hospital. Samples of MEE were taken for bacterial culture. RESULTS The average severity score was 6.6 (out of 16). The severity score in the pathogen-positive MEE group was significantly higher than that in the pathogen-negative MEE group (p<0.05). The score was not significantly different between the seasons. Linear multiple regression analysis showed that BMI and the duration of bronchial asthma significantly affected the EOM severity score (p<0.05). The presence of aspirin intolerant asthma tended to be correlated with the severity score. The Lund-Mackay score tended to be negatively correlated with it. CONCLUSIONS There is a significant association between the severity of EOM and obesity, as well as with the duration of bronchial asthma.
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Affiliation(s)
- Hiromi Kanazawa
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| | - Naohiro Yoshida
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiroki Yamamoto
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Mariko Hara
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masayo Hasegawa
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shingo Matsuzawa
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akihiro Shinnabe
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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28
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Tanaka Y, Nonaka M, Yamamura Y, Tagaya E, Pawankar R, Yoshihara T. Improvement of eosinophilic otitis media by optimized asthma treatment. Allergy Asthma Immunol Res 2013; 5:175-8. [PMID: 23638317 PMCID: PMC3636453 DOI: 10.4168/aair.2013.5.3.175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/22/2012] [Accepted: 11/15/2012] [Indexed: 11/20/2022]
Abstract
Eosinophilic otitis media (EOM) shows a very high rate of association with asthma, and intractable otitis media involves marked eosinophil infiltration into the middle ear. The middle ear space is connected to the nasopharynx by the Eustachian tube, and it is considered a part of the upper respiratory tract. Allergic rhinitis and asthma often coexist as chronic inflammatory diseases of the upper and lower airways, respectively, and have an impact on each other. In fact, inhaled corticosteroids reduce seasonal eosinophilia systemically in the circulation and locally in the nasal mucosa, as well as attenuate seasonal nasal symptoms. We report a case of EOM associated with adult-onset asthma that improved following optimal asthma therapy after changing the treatment from inhaled fluticasone propionate (FP) (200 µg b.i.d.) to a combination of FP/salmeterol (250/50 µg b.i.d.). This result supports the hypothesis that EOM and asthma are closely linked, presenting as different manifestations of a similar disease syndrome.
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Affiliation(s)
- Yukako Tanaka
- Department of Otolaryngology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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29
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Chung WJ, Lee JH, Lim HK, Yoon TH, Cho KJ, Baek JH. Eosinophilic otitis media: CT and MRI findings and literature review. Korean J Radiol 2012; 13:363-7. [PMID: 22563277 PMCID: PMC3337876 DOI: 10.3348/kjr.2012.13.3.363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/28/2011] [Indexed: 11/15/2022] Open
Abstract
Eosinophilic otitis media (EOM) is a relatively rare, intractable, middle ear disease with extremely viscous mucoid effusion containing eosinophils. EOM is associated with adult bronchial asthma and nasal allergies. Conventional treatments for otitis media with effusion (OME) or for chronic otitis media (COM), like tympanoplasty or mastoidectomy, when performed for the treatment of EOM, can induce severe complications such as deafness. Therefore, it should be differentiated from the usual type of OME or COM. To our knowledge, the clinical and imaging findings of EOM of temporal bone are not well-known to radiologists. We report here the CT and MRI findings of two EOM cases and review the clinical and histopathologic findings of this recently described disease entity.
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Affiliation(s)
- Won Jung Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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