Case reports of eosinophilio otitis media Clinical aspects of eosinophilic otitis midia

摘要

Eosinophilic Otitis Media is a new disease entity characterized by very thick middle ear effusion, which is accompanied by bronchial asthma and allergic rhinitis. The characteristics of eosinophilic otitis media are as follows: 1) All the patients suffered from severe bronchial asthma the onset of which occurred in adulthood. 2) Nasal polyps and chronic sinusitis frequently occurred and heavy infiltration of eosinophils into the polyps was usually observed. 3) In many patients, both ears were affected. These conditions were characterized by a gelatin-like secretion. 4) Surgical treatment was not effective. 5) It is sometimes complicated with sensorineural hearing loss. We presented 15 cases of eosinophilic otitis media at Asahikawa Medical College Hospital and related institutions. All cases had bronchial asthma, 10 had chronic sinusitis, 7 had nasal polyps, 8 had allergic rhinitis, and 12 had hyposmia. One case had sensorineural hearing loss. A high IgE value or a positive serum RAST score existed in 7 cases. Myringotomy, corticosteroid eardrops, and anti-allergic drugs were used for primary treatments. Patients underwent systemic administration of predonisolon in case of initial treatments failure or progress of sensorineural hearing loss. Otologic findings improved in all 8 cases treated with systemic prednisolone. In these cases that required prednisolone, there were tendencies for more uncontrollable asthma, or longer-lasting ear symptoms. Recently we began to use triamcinolon acetonide directly into tympanic cavity through perforations or tympanostomy tube. It was effective for persistent otorrhea and reduced the chance of systemic use of predonisolone. Systemic use of predonisolone might be the most effective treatment manner. Although we have not experienced major side effects caused by systemic use of predonisolone, it is necessary for us to have other treatment options that much effective with less possibility of side effects.