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Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept.
J Allergy Clin Immunol. 2004 Nov; 114(5):1110-5.JA

Abstract

BACKGROUND

Otitis media with effusion (OME) is a chronic inflammatory disease of the middle ear space characterized by the accumulation of fluid. Previous investigations have suggested that the immunopathologic mechanism underlying the development of middle ear effusion in patients with allergy is largely due to the effects of T(H)2 mediators. The composition of the inflammatory substrate in the effusions of allergic otitis media is similar to the late-phase allergic response seen elsewhere in the respiratory tract, such as in asthma and in allergic rhinitis.

OBJECTIVE

To determine whether the middle ear compartment may be a component of the united airways in allergic disease by comparing the inflammatory profiles of the middle ear to the upper airway.

METHODS

Middle ear effusions, torus tubaris (Eustachian tube mucosa at the nasopharyngeal orifice), and adenoidal tissue biopsies were obtained from 45 patients undergoing simultaneous tympanostomy tube placement for OME and adenoidectomy for adenoid hypertrophy. The cellular and cytokine profiles of each site were investigated by using immunocytochemistry (elastase, CD3, major basic protein) and in situ hybridization (IL-4, IL-5, IFN-gamma mRNA). Atopic status was determined for each patient by using skin prick testing.

RESULTS

Eleven of the 45 patients with OME (24%) were atopic. The middle ear effusions of atopic patients had significantly higher levels of eosinophils, T lymphocytes, and IL-4 mRNA + cells (P < .01) and significantly lower levels of neutrophils and IFN-gamma mRNA + cells (P < .01) compared with nonatopic patients. The nasopharyngeal tissue biopsies revealed similar cellular and cytokine profiles.

CONCLUSION

In atopic patients with OME, the allergic inflammation occurs on both sides of the Eustachian tube, both in the middle ear and in the nasopharynx. The results of this study support the concept that the middle ear may be part of the united airway in atopic individuals.

Authors+Show Affiliations

Nguyen LH
Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.
Manoukian JJ
No affiliation info available
Sobol SE
No affiliation info available
Tewfik TL
No affiliation info available
Mazer BD
No affiliation info available
Schloss MD
No affiliation info available
Taha R
No affiliation info available
Hamid QA
No affiliation info available

MeSH

AdenoidsAdolescentChildChild, PreschoolEar, MiddleFemaleHumansHypersensitivityInfantInterferon-gammaMaleNasopharynxOtitis Media with EffusionProspective Studies

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15536418

Citation

Nguyen, Lily H P., et al. "Similar Allergic Inflammation in the Middle Ear and the Upper Airway: Evidence Linking Otitis Media With Effusion to the United Airways Concept." The Journal of Allergy and Clinical Immunology, vol. 114, no. 5, 2004, pp. 1110-5.
Nguyen LH, Manoukian JJ, Sobol SE, et al. Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. J Allergy Clin Immunol. 2004;114(5):1110-5.
Nguyen, L. H., Manoukian, J. J., Sobol, S. E., Tewfik, T. L., Mazer, B. D., Schloss, M. D., Taha, R., & Hamid, Q. A. (2004). Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. The Journal of Allergy and Clinical Immunology, 114(5), 1110-5.
Nguyen LH, et al. Similar Allergic Inflammation in the Middle Ear and the Upper Airway: Evidence Linking Otitis Media With Effusion to the United Airways Concept. J Allergy Clin Immunol. 2004;114(5):1110-5. PubMed PMID: 15536418.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. AU - Nguyen,Lily H P, AU - Manoukian,John J, AU - Sobol,Steven E, AU - Tewfik,Ted L, AU - Mazer,Bruce D, AU - Schloss,Melvin D, AU - Taha,Rame, AU - Hamid,Qutayba A, PY - 2004/11/13/pubmed PY - 2004/12/16/medline PY - 2004/11/13/entrez SP - 1110 EP - 5 JF - The Journal of allergy and clinical immunology JO - J Allergy Clin Immunol VL - 114 IS - 5 N2 - BACKGROUND: Otitis media with effusion (OME) is a chronic inflammatory disease of the middle ear space characterized by the accumulation of fluid. Previous investigations have suggested that the immunopathologic mechanism underlying the development of middle ear effusion in patients with allergy is largely due to the effects of T(H)2 mediators. The composition of the inflammatory substrate in the effusions of allergic otitis media is similar to the late-phase allergic response seen elsewhere in the respiratory tract, such as in asthma and in allergic rhinitis. OBJECTIVE: To determine whether the middle ear compartment may be a component of the united airways in allergic disease by comparing the inflammatory profiles of the middle ear to the upper airway. METHODS: Middle ear effusions, torus tubaris (Eustachian tube mucosa at the nasopharyngeal orifice), and adenoidal tissue biopsies were obtained from 45 patients undergoing simultaneous tympanostomy tube placement for OME and adenoidectomy for adenoid hypertrophy. The cellular and cytokine profiles of each site were investigated by using immunocytochemistry (elastase, CD3, major basic protein) and in situ hybridization (IL-4, IL-5, IFN-gamma mRNA). Atopic status was determined for each patient by using skin prick testing. RESULTS: Eleven of the 45 patients with OME (24%) were atopic. The middle ear effusions of atopic patients had significantly higher levels of eosinophils, T lymphocytes, and IL-4 mRNA + cells (P < .01) and significantly lower levels of neutrophils and IFN-gamma mRNA + cells (P < .01) compared with nonatopic patients. The nasopharyngeal tissue biopsies revealed similar cellular and cytokine profiles. CONCLUSION: In atopic patients with OME, the allergic inflammation occurs on both sides of the Eustachian tube, both in the middle ear and in the nasopharynx. The results of this study support the concept that the middle ear may be part of the united airway in atopic individuals. SN - 0091-6749 UR - https://www.unboundmedicine.com/medline/citation/15536418/Similar_allergic_inflammation_in_the_middle_ear_and_the_upper_airway:_evidence_linking_otitis_media_with_effusion_to_the_united_airways_concept_ DB - PRIME DP - Unbound Medicine ER -