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Di Berardino F, Zanetti D, Monzani D, Rossaro B, Cantarella G, Dejonckere P, Pignataro L. The Atopy Index Inventory: A Brief and Simple Tool to Identify Atopic Patients. ORL J Otorhinolaryngol Relat Spec 2020; 82:285-294. [PMID: 32791498 DOI: 10.1159/000508813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Atopy and ear, nose and throat (ENT) diseases are frequently associated; however, no clinical tool has been proposed so far to discriminate which patients could be atopic and therefore deserving of a further immunoallergological evaluation. OBJECTIVE The aim of this study was to assess and validate a set of dichotomous responses suitable for predicting the presence of atopy in adult patients. METHODS An 11-item questionnaire, i.e., the Atopy Index Inventory (AII), comprised of 4 questions regarding the clinical history for allergic disease and 7 questions evaluating the presence of the most frequent clinical signs affecting allergic patients, was developed and administered to 226 adult subjects (124 atopic subjects and 102 healthy, not atopic subjects). The atopic condition was proven by an immunoallergological evaluation according to the diagnostic criteria of the EAACI guidelines. Internal consistency and clinical validity were tested. RESULTS In healthy subjects, the first 4 variables of the AII returned a 100% correct response (all answered "no") and were defined as "decisive" responses. In the logistic regression analysis, when decisive items were negative, the atopic condition was confirmed when answering "yes" to at least 3 "probability" items (cut-off = 2.69). The difference in AII scores between allergic and healthy group was significant using the Mann-Whitney U test (p < 0.0001). The sensitivity and specificity of the AII were 0.97 and 0.91, respectively, with a true predictive value of 0.92 and a false predictive value of 0.97. The ROC curve showed an area of 0.94, with an OR of 0.88 (95% CI 0.87-0.97, p = 0.0001). The internal consistency as determined by the Cronbach α coefficient was 0.88. CONCLUSION The AII has been proven to be a brief, simple and sufficiently accurate tool for screening ENT patients in search of atopic individuals and to allow their clinical management.
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Affiliation(s)
- Federica Di Berardino
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy,
| | - Diego Zanetti
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy
| | - Daniele Monzani
- ENT Department, Policlinico di Modena University Hospital, Modena, Italy
| | - Bruno Rossaro
- DeFENS (Department of Food, Environmental, and Nutritional Sciences), University of Milan, Milan, Italy
| | - Giovanna Cantarella
- ENT Unit, Department of Biomedical, Surgical, and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy
| | | | - Lorenzo Pignataro
- ENT Unit, Department of Biomedical, Surgical, and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, DISCCO (Department of Clinical Sciences and Community Health), University of Milan, Milan, Italy
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Hurst DS, Denne CM. The Relation of Allergy to Eustachian Tube Dysfunction and the Subsequent Need for Insertion of Pressure Equalization Tubes. EAR, NOSE & THROAT JOURNAL 2020; 99:39S-47S. [PMID: 32320297 DOI: 10.1177/0145561320918805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The most basic question to be answered in each case in which the choice of using a pressure equalization tube (PET) is being considered is: "what is the underlying pathophysiology of the middle ear disease being addressed?" METHODS We will evaluate the hypothesis that the Eustachian Tube (ET) may become "dysfunctional" due to allergic mucosal edema and obstruction. We review the literature that evaluates the role of ET, the proposed affect that allergy may contribute to ET dysfunction (ETD), and the relation of allergic rhinitis to otitis. RESULTS Proof that allergy affects the middle ear was supported by (1) over a dozen investigators using objective immunotherapy demonstrating over the past 70 years that 72% to 100% of the children with otitis media with effusion (OME) are atopic, (2) an association of allergic Th2 immune-mediated histochemical reactivity within the target organ itself, (3) establishment that inflammation within the middle ear is truly allergic in nature, and (4) direct evidence of a dose-response curve and consistency of results, which confirm that OME resolves on allergy immunotherapy. CONCLUSION Current medical evidence should heighten the awareness of physicians of the physiology that underlies ETD. The evidence supports the link between allergy and OME. The middle ear behaves like the rest of the respiratory tract, and what has been learned about the atopic response in the sinuses and lungs may be applied to the study of the immunologic mechanisms within the middle ear that lead to ETD requiring the use of PET.
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Affiliation(s)
- David S Hurst
- Otolaryngology, 1867Tufts University, Boston, MA, USA
| | - Carter M Denne
- 6595University of Pittsburg Medical Center, Erie, PA, USA
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Zernotti ME, Pawankar R, Ansotegui I, Badellino H, Croce JS, Hossny E, Ebisawa M, Rosario N, Sanchez Borges M, Zhang Y, Zhang L. Otitis media with effusion and atopy: is there a causal relationship? World Allergy Organ J 2017; 10:37. [PMID: 29158869 PMCID: PMC5684754 DOI: 10.1186/s40413-017-0168-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 09/13/2017] [Indexed: 12/14/2022] Open
Abstract
Otitis Media with Effusion (OME) is an inflammatory condition of the middle ear cleft, acute or chronic, with collection of fluid in the middle ear with an intact tympanic membrane. It is a very common disease in childhood, the most frequent cause of hearing loss in childhood and often requiring surgery. OME is called chronic when the fluid in the middle ear persists for more than three months or when the episodes recur six or more times in one year. The current article covers various aspects of OME including definition, epidemiology. Pathomechanisms, risk factors, role of allergy in OME, impact of upper airway disease on OME, eosinophilic otitis media and management of OME.
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Affiliation(s)
- Mario E. Zernotti
- Department of Otolaryngology, Catholic University of Córdoba, Córdoba, Argentina
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - Hector Badellino
- Department of Pediatric Respiratory Medicine, Regional Eastern Clinic, San Francisco, Córdoba, Argentina
| | | | - Elham Hossny
- Pediatric Allergy Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
| | - Motohiro Ebisawa
- Department of Pediatrics, National Sagamihara Hospital, Sagamihara-shi, Kanagawa Japan
| | | | - Mario Sanchez Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Yuan Zhang
- Department of Otolaryngology – Head and Neck Surgery, Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology – Head and Neck Surgery, Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
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Harju T, Kivekäs I, Numminen J, Rautiainen M. Eustachian Tube Dysfunction-Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement. Ann Otol Rhinol Laryngol 2017; 126:798-803. [PMID: 28975810 DOI: 10.1177/0003489417735538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between chronic nasal obstruction caused by inferior turbinate enlargement and Eustachian tube dysfunction-related symptoms using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) as an assessment method. METHODS A total of 80 adults were enrolled. Group 1 comprised consecutive patients with enlarged inferior turbinates and group 2 comprised healthy controls. The ETDQ-7 scores and tympanometry results of both groups were analyzed and compared. RESULTS The median total scores of the ETDQ-7 in groups 1 and 2 were 1.9 (interquartile range, 1.4-2.8) and 1.1 (interquartile range, 1.0-1.7), respectively ( P < .001). There was no significant difference in the abnormal tympanometry results between the groups. There was no significant difference in the ETDQ-7 total score between the patients with allergic sensitization and other patients in group 1. CONCLUSIONS Patients with inferior turbinate enlargement have more symptoms related to Eustachian tube dysfunction than healthy controls. Most patients with Eustachian tube dysfunction had normal tympanometry and normal otoscopy, which indicates a baro-challenge-induced Eustachian tube dysfunction. Whether the patient has allergic sensitization or not does not seem to cause a difference in symptoms related to Eustachian tube dysfunction.
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Affiliation(s)
- Teemu Harju
- 1 Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Ilkka Kivekäs
- 1 Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Jura Numminen
- 1 Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- 1 Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
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Otitis media with effusion in an allergic animal model: A functional and morphological study. Int J Pediatr Otorhinolaryngol 2016; 84:6-11. [PMID: 27063745 DOI: 10.1016/j.ijporl.2016.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Allergy is considered as one of important etiologic factor of otitis media with effusion (OME). In present study, we evaluated the causal effect of allergy on OME in an animal model, and investigated the secondary effect of bacterial infection. METHODS Allergy and control animals were subdivided into groups with and without intratympanic injection of lipopolysaccharide (IT-LPS). Allergic otitis media was induced via intraperitoneal ovo-albumin injection with intranasal challenge. We assessed the occurrence of OME in allergic animals and the effect of IT-LPS on allergic otitis media. We also investigated the Th1 and Th2 responses in the middle-ear mucosa. Hearing of the animals was measured by ABR and DPOAE. RESULTS OME was observed in 75% of the allergic animals. After IT-LPS, 100% of the control and allergy groups showed otitis media. Light microscopy revealed that the middle-ear mucosa of animals of both groups also was significantly increased after IT-LPS, and the Th1 response (IL-2 and IFN-γ) and Th2 response (IL-5 and IL-13) cytokines were expressed at higher levels in the allergy group with IT-LPS than in control group with IT-LPS. Hearing tests between the allergy and control group with IT-LPS did not reveal any differences. CONCLUSION Our findings may be direct evidence of an allergic causal effect on OME. Th2 response cytokines were strongly expressed in allergic OME, and the inflammatory reaction to LPS was more intense in the allergic group, which indicates that otitis media related to allergy can be severely aggravated by an inflammatory reaction to bacterial infection.
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Kim WJ, Kim BG, Chang KH, Oh JH. Detection of bacteria in middle ear effusions based on the presence of allergy: does allergy augment bacterial infection in the middle ear? J Otolaryngol Head Neck Surg 2015; 44:58. [PMID: 26714647 PMCID: PMC4696230 DOI: 10.1186/s40463-015-0111-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/16/2015] [Indexed: 11/12/2022] Open
Abstract
Background Bacterial infection, Eustachian tube dysfunction, allergies, and immunologic factors are major causes of otitis media with effusion (OME). However, the exact pathogenesis of OME is still unclear. This study evaluated whether allergy influences bacterial growth in middle ear effusions. Materials Fifty-four samples were obtained from OME patients 3–10 years of age who underwent ventilation tube insertion and were divided into two groups based on the presence of allergy as determined using the multiple allergosorbent test (MAST). Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis bacterial DNA in the middle ear effusions was analyzed using polymerase chain reaction. Overall detection rates and those for each species were compared between the two groups. Results Of the 54 middle ear effusion samples, 38 (70.4 %) contained bacterial DNA and 14 (36.8 %) of these contained DNA from multiple species. S. pneumoniae was detected in 27 samples (50 %), H. influenzae in 17 samples (31.4 %), and M. catarrhalis in 9 samples (16.6 %). There was no significant difference in the bacterial detection rates between the middle ear effusions of the MAST-positive and MAST-negative groups. Conclusion The rate of bacteria detection in middle ear effusions did not differ between allergic and non-allergic children.
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Affiliation(s)
- Woo Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Byung-Guk Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Ki-Hong Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Jeong-Hoon Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. .,Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, 180 Wangsan-Ro, Dongdaemun-Gu, Seoul, 130-709, South Korea.
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Pro-inflammatory interleukins in middle ear effusions from atopic and non-atopic children with chronic otitis media with effusion. Eur Arch Otorhinolaryngol 2015; 273:1369-78. [DOI: 10.1007/s00405-015-3683-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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Ben Gamra O, Nacef I, Abid W, Hariga I, Mbarek C. Myringoplasty in children: Our results. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ejenta.2014.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sensitivity of ABR based newborn screening with the MB11 BERAphone(®). Int J Pediatr Otorhinolaryngol 2014; 78:756-61. [PMID: 24642417 DOI: 10.1016/j.ijporl.2014.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/30/2014] [Accepted: 02/01/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the sensitivity of our hearing screening program. The evaluation was done using a questionnaire for parents of children who participated in the NHS for a targeted time frame of two years. A survey was accomplished to identify children who passed our screening protocol in the newborn period, but who were later identified to have hearing loss. METHODS For the survey a one-year cohort was established in 2008 which included 500 children who received a hearing screening at our Center with the ABR newborn screener, MB11 BERAphone(®), two years before. Two hearing questionnaires were chosen for the survey. The LittlEARS questionnaire (MED-EL Medical Electronics GmbH) for investigating the hearing behavior of the children during the first two years of life and a second, custom-developed questionnaire (Würzburger questionnaire) investigating some aspects which are not included in the LittlEARS tool, such as speech/language development, general development as well as pathological factors that might eventually lead to a temporary hearing loss. RESULTS Analysis of the Würzburger questionnaires revealed normal speech development for 92.9% of the children. For 4.7% male and 2.4% female children delayed speech development was reported. Although twice as many males were found, the statistical comparison showed no significant difference according to gender. The results of the LittlEARS questionnaire are identical to those of the Würzburger questionnaire in 98.3% of the investigated cases and in 1.7% of the cases slightly different results but on borderline: The LittlEAR scores showed normal auditory development for the childrens' age but the Würzburger questionnaire results showed delayed speech development. CONCLUSIONS Based on the follow-up analysis and the results from the two questionnaires, no permanent hearing loss was found in any child two years after they passed the newborn hearing screening. Thus, we conclude that the sensitivity of the screening test was 100%, based on survey results 2 years post screening.
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Passali D, Passali GC, Lauriello M, Romano A, Bellussi L, Passali FM. Nasal Allergy and Otitis Media: A real correlation? Sultan Qaboos Univ Med J 2014; 14:e59-64. [PMID: 24516755 DOI: 10.12816/0003337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 01/19/2013] [Accepted: 06/18/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion (OME) and persistent allergic rhinitis symptoms versus intermittent rhinitis in children. METHODS The study included 100 atopic children (52 boys, 48 girls) aged 5-9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests (SPTs), mucociliary transport time (MCTt) and Eustachian tube function tests were performed. RESULTS The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus, 34 to grass pollen and 16 to Parietaria. Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group (21 ± 2 mins) versus the intermittent group (16 ± 2 mins) with a significant difference (P <0.01). Mean eosinophil cationic protein (ECP) values in the middle ear effusions of children who had undergone myringotomy were 251 ± 175.2 μg/L, and mean ECP blood values were 25.5 ± 16.3 μg/L, with significant differences (P < 0.001). CONCLUSION There was a significant association between OME, delayed MCTt, ECP values in middle ear effusion and persistent symptoms of allergic rhinitis. These results suggest a direct involvement of the middle ear mucosa as a target organ in persistent forms.
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