Allergy Asthma Immunol Res.  2013 May;5(3):175-178. 10.4168/aair.2013.5.3.175.

Improvement of Eosinophilic Otitis Media by Optimized Asthma Treatment

• Tanaka Y
• Nonaka M
• Yamamura Y
• Tagaya E
• Pawankar R
• Yoshihara

• KMID: 2260338
• DOI: http://doi.org/10.4168/aair.2013.5.3.175

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 microg b.i.d.) to a combination of FP/salmeterol (250/50 microg b.i.d.). This result supports the hypothesis that EOM and asthma are closely linked, presenting as different manifestations of a similar disease syndrome.

Keyword

Eosinophilic otitis media; asthma; inhalation therapy

MeSH Terms

Adrenal Cortex Hormones
Androstadienes
Asthma
Diethylpropion
Ear, Middle
Eosinophilia
Eosinophils
Eustachian Tube
Nasal Mucosa
Nasopharynx
Otitis
Otitis Media
Respiratory System
Respiratory Therapy
Rhinitis
Rhinitis, Allergic, Perennial
Seasons
Fluticasone
Adrenal Cortex Hormones
Androstadienes
Diethylpropion

Figure

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  Fig. 1 Tympanic membrane findings (right ear). (A) Prior to optimizing asthma treatment (i.e., prior to using the combination of inhaled FSC). Glue-like otorrhea is observed exuding from the tympanic membrane perforation. (B) Following optimized asthma treatment (i.e., after starting FSC). The glue-like otorrhea exuding from the tympanic membrane perforation has disappeared.

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  Fig. 2 Audiometry. Yellow color: prior to optimizing asthma treatment. Blue color: following optimized asthma treatment.

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  Fig. 3 Computed tomography images. (A) Prior to optimizing asthma treatment (i.e., prior to using FSC). Soft-tissue shadows are observed extending from the Eustachian tube to the tympanic cavity. (B) Following optimized asthma treatment (i.e., after starting FSC). The soft-tissue shadow in the Eustachian tube is reduced, whereas the shadow in the tympanic cavity has disappeared. FSC, fluticasone propionate 250 µg and salmeterol 50 µg.

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