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Arima M, Ito K, Abe T, Oguma T, Asano K, Mukherjee M, Ueki S. Eosinophilic mucus diseases. Allergol Int 2024; 73:362-374. [PMID: 38594175 DOI: 10.1016/j.alit.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 04/11/2024] Open
Abstract
Eosinophilic inflammation is primarily characterized by type 2 immune responses against parasitic organisms. In the contemporary human being especially in developed countries, eosinophilic inflammation is strongly associated with allergic/sterile inflammation, and constitutes an undesired immune reaction. This situation is in stark contrast to neutrophilic inflammation, which is indispensable for the host defense against bacterial infections. Among eosinophilic inflammatory disorders, massive accumulation of eosinophils within mucus is observed in certain cases, and is often linked to the distinctive clinical finding of mucus with high viscosity. Eosinophilic mucus is found in a variety of diseases, including chronic allergic keratoconjunctivitis, chronic rhinosinusitis encompassing allergic fungal sinusitis, eosinophilic otitis media, eosinophilic sialodochitis, allergic bronchopulmonary aspergillosis/mycosis, eosinophilic plastic bronchitis, and eosinophilic asthma. In these pathological conditions, chronic inflammation and tissue remodeling coupled with irreversible organ damage due to persistent adhesion of toxic substances and luminal obstruction may impose a significant burden on the body. Eosinophils aggregate in the hyperconcentrated mucus together with cell-derived crystals, macromolecules, and polymers, thereby affecting the biophysical properties of the mucus. This review focuses on the clinically significant challenges of mucus and discusses the consequences of activated eosinophils on the mucosal surface that impact mucus and persistent inflammation.
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Affiliation(s)
- Misaki Arima
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Keisuke Ito
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomoe Abe
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Manali Mukherjee
- Department of Medicine, McMaster University & St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan.
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Suikkila A, Lyly A, Savinko T, Vento SI, Saarinen R, Hafrén L. Inflammatory Cytokines in Middle Ear Effusion of Patients With Asthma, Chronic Rhinosinusitis With Nasal Polyps With or Without NSAID Intolerance. Otol Neurotol 2024:00129492-990000000-00560. [PMID: 38896805 DOI: 10.1097/mao.0000000000004230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To measure the inflammatory cytokines of middle ear effusion (MEE) in otitis media (OM) associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) with or without nonsteroidal anti-inflammatory drug (NSAID) sensitivity to strengthen our assumption that OM is part of the same inflammatory entity. The potential individual differences between MEE inflammatory cytokines could be used in clinical practice for more individual characterization of the inflammation. STUDY DESIGN Case-control study. SETTING Tertiary referral center. PATIENTS Convenience sample of 24 case patients with otitis media with effusion (OME) or chronic otitis media (COM), asthma, and CRSwNP, 14 of whom had NSAID intolerance, and 8 controls with OME but no history of asthma, CRSwNP, or NSAID intolerance. INTERVENTION Diagnostic. MAIN OUTCOME AND MEASURE Inflammatory cytokines including interleukins (IL)-4, IL-5, IL-6, IL-13, and interferon gamma (IFN-γ) in middle ear effusion. RESULTS The MEE mass fractions of IL-5 (p = 0.003) and IFN-γ (p = 0.048) were higher among our case patients with OME/COM than among the controls. For IL-4 and IL-13, the mass fractions were also higher among the case patients than the controls, but this difference was not statistically significant (p = 0.199 and p = 0.617, respectively). We found no difference between the IL-6 mass fractions of the groups. We found notable heterogeneity in individual patients' cytokine levels. CONCLUSIONS According to our findings, OM, when present, should be considered part of the respiratory inflammatory process associated with asthma and CRSwNP. The individual differences in MEE cytokine levels could be useful as biomarkers.
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Affiliation(s)
- Anna Suikkila
- Department of Otorhinolaryngology-Head and Neck surgery, University of Helsinki and Helsinki University Hospital
| | | | - Terhi Savinko
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Seija I Vento
- Department of Otorhinolaryngology-Head and Neck surgery, University of Helsinki and Helsinki University Hospital
| | - Riitta Saarinen
- Department of Otorhinolaryngology-Head and Neck surgery, University of Helsinki and Helsinki University Hospital
| | - Lena Hafrén
- Department of Otorhinolaryngology-Head and Neck surgery, University of Helsinki and Helsinki University Hospital
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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. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 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] [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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Fedin AV. [Clinical observation of the course of eosinophilic otitis media against the background of biological therapy of chronic polypous rhinosinusitis]. Vestn Otorinolaringol 2024; 89:95-100. [PMID: 38805470 DOI: 10.17116/otorino20248902195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
RESUME Eosinophilic otitis media (EoOM) is a variant of exudative otitis media characterized by a persistent persistent course, the presence of a very viscous effusion in the tympanic cavity, comorbidally associated with chronic polypous rhinosinusitis and bronchial asthma. The disease is characterized by a persistent progressive course, which can lead to a gradual decrease in hearing up to complete deafness. Conservative treatment methods for EoOM include local and systemic administration of glucocorticosteroids. Encouraging data on the effectiveness of biological therapy have appeared in recent publications. The above clinical observation examines the course of EoOM in a patient who received biological therapy with dupilamab.
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Affiliation(s)
- A V Fedin
- Zakharyin Clinical Hospital No. 6, Penza, Russia
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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] [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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Urabe K, Ohta Y, Fujii S, Tsuda T, Inohara H. An Unusual Case of Eosinophilic Chronic Rhinosinusitis With Concurrent Eosinophilic Otitis Media: Limited Responsiveness to Multiple Antibody Therapies and Subsequent Cochlear Implantation. Cureus 2023; 15:e49033. [PMID: 38116349 PMCID: PMC10728607 DOI: 10.7759/cureus.49033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Eosinophilic chronic rhinosinusitis (ECRS) and eosinophilic otitis media (EOM) are debilitating inflammatory conditions that affect the paranasal sinuses and middle ear, respectively, and are characterized by eosinophilic infiltration. This study describes a rare and intricate case of a 65-year-old male patient concurrently afflicted with ECRS, EOM, and bronchial asthma. Despite the systematic administration of corticosteroids and various antibody drugs, the patient's condition remained unimproved, necessitating a cochlear implant for EOM, which is seldom an aggressive intervention. The patient had a history of symptoms dating back to 2005, with notable exacerbations and treatment resistance over the years. Multiple antibody drugs, including anti-IgE, anti-IL-5, and anti-IL-4α antibodies, failed to ameliorate the patient's condition, presenting a significant clinical challenge. Pathological examination revealed marked eosinophilic infiltration and severe fibrosis, suggesting a possible mechanism underlying the poor response to antibody therapy. Cochlear implantation significantly enhanced the patient's communicative abilities. This case highlights the limitations of the current antibody drugs in managing severely intertwined cases of ECRS, EOM, and bronchial asthma, highlighting the need for novel therapeutic strategies. This case also propounds cochlear implantation as an efficacious intervention for refractory EOM with severe sensorineural hearing impairment, extending the spectrum of treatment modalities for such challenging scenarios. This singular case contributes to the growing body of evidence regarding the management of ECRS and EOM, especially against the backdrop of treatment resistance, and can aid clinicians in identifying and navigating similar complex cases in clinical practice.
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Affiliation(s)
- Kosuke Urabe
- Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Faculty of Medicine, Osaka University, Suita, JPN
| | - Yumi Ohta
- Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Faculty of Medicine, Osaka University, Suita, JPN
| | - Soichiro Fujii
- Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Faculty of Medicine, Osaka University, Suita, JPN
| | - Takeshi Tsuda
- Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Faculty of Medicine, Osaka University, Suita, JPN
| | - Hidenori Inohara
- Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Faculty of Medicine, Osaka University, Suita, JPN
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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] [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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Zaubitzer L, Rotter N, Schell A. [Intratympanic Drug Application - Indication and Procedure]. Laryngorhinootologie 2023; 102:693-705. [PMID: 37657433 DOI: 10.1055/a-1961-5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Neurootologic disorders of the inner ear associated with symptoms such as tinnitus, vertigo, and hearing loss are common and often cause significant distress to affected patients. Treatment options are usually limited. There are now some indications for which intratympanic drug application is a possible treatment option. Intratympanic drug administration is a simple, inexpensive therapy option with few side effects that can be used on an outpatient basis. Therefore, it should not be disregarded when indicated.
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Sakaida H, Takeuchi K. Allergic Fungal Otomastoiditis: A Case Report. Cureus 2023; 15:e45446. [PMID: 37727842 PMCID: PMC10506369 DOI: 10.7759/cureus.45446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/21/2023] Open
Abstract
Otomastoiditis caused by an allergic reaction to fungi in the middle ear is rare, with only four cases reported in the English literature. We report the case of a patient with allergic fungal otomastoiditis. A 28-year-old man presented with otalgia, hearing loss, and vertigo. Exploratory tympanotomy revealed mucin with a peanut butter-like consistency and containing eosinophils and Candida parapsilosis, but no evidence of direct tissue invasion by fungi. The patient was treated with a combination of surgery and medication. Subtotal petrosectomy was finally performed to remove the middle ear mucosa and separate the middle ear from the external environment. Short-term prednisolone and long-term fluconazole were administered without satisfactory therapeutic results. The inflammatory condition has improved but continues without complete remission. Allergic fungal otomastoiditis is an extremely rare condition that may share pathophysiological features with allergic fungal rhinosinusitis, so a thorough examination combining bacterial cultures, histopathological examination with fungal staining, and serum antigen-specific immunoglobulin E against multiple fungi is essential. Optimal treatment probably comprises appropriate surgery and long-term administration of systemic corticosteroids. Definitive diagnostic criteria and therapeutic strategies need to be established, based on the accumulation of similar cases.
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Affiliation(s)
- Hiroshi Sakaida
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, JPN
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, JPN
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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] [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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Kikuchi S, Yoshida S, Sugiyama T, Iino Y. Myringoplasty for Eosinophilic Otitis Media. Otol Neurotol 2023; 44:572-577. [PMID: 37231536 DOI: 10.1097/mao.0000000000003904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Surgical intervention of eosinophilic otitis media (EOM) has been considered contraindicated because middle ear surgery is associated with a risk of deafness. Myringoplasty is believed to be less invasive. Therefore, we analyzed the surgical results of myringoplasty for perforated eardrums in patients with EOM treated by biological drugs (biologics). STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Nine ears of seven patients with EOM with eardrum perforation associated with bronchial asthma were treated with add-on biologics; myringoplasty was then performed. The controls comprised 17 ears of 11 patients with EOM treated by myringoplasty without biologics. INTERVENTIONS The EOM status of each patient of both groups was assessed using severity scores, hearing acuity, and temporal bone computed tomography scores. MAIN OUTCOME MEASURES Preoperative and postoperative changes in severity scores and hearing acuity, postoperative closure of the perforation, and relapse of EOM. RESULTS Severity scores significantly decreased after the use of biologics but did not change after myringoplasty. One patient developed postoperative relapse of middle ear effusion (MEE); in the control group, however, 10 ears developed recurrence of MEE. Significant improvement of the air conduction hearing level was obtained in the biologics group. No patients showed deterioration of the bone conduction hearing level. CONCLUSIONS This is the first report to describe successful surgical interventions with add-on biologics for patients with EOM. In the era of biologics, surgical interventions such as myringoplasty will be indicated to improve hearing and to avoid recurrence of MEE in patients with EOM with perforated eardrums, with the use of biologics.
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Affiliation(s)
- Saori Kikuchi
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saeko Yoshida
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Tomonori Sugiyama
- Department of Otolaryngology/Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
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Calvo-Henriquez C, Di Corso E, Alobid I, Cantone E, Di Cesare T, Mullol J. Pathophysiological Link Between Chronic Rhinosinusitis and Ear Disease. Curr Allergy Asthma Rep 2023; 23:389-397. [PMID: 37395977 DOI: 10.1007/s11882-023-01072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW In the clinical practice, patients affected by chronic rhinosinusitis (CRS) commonly complain of otologic symptoms. This review aims to describe the available literature evidence assessing the relationship between CRS and ear illnesses published in the last 5 years. RECENT FINDINGS Available evidence suggests a higher prevalence of otologic symptoms in patients suffering from CRS, affecting up to 87% of patients. These symptoms may be related to Eustachian tube dysfunction, which improves after treatment for CRS. A few studies suggested a potential but not confirmed role of CRS in cholesteatoma, chronic otitis media, and sensorineural hypoacusis. A special type of otitis media with effusion (OME) may occur in patients with CRS, which seems to respond well to new biologic therapy. Ear symptoms appear to be highly prevalent in patients with CRS. So far, the available evidence is robust only for Eustachian tube dysfunction, which has been shown to be particularly impaired in CRS patients. Additionally, the Eustachian tube function appears to improve after treatment for CRS. Finally, interesting preliminary data were described for eosinophilic otitis media, as it appears to respond well to the treatment with biologics.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Eugenio Di Corso
- Unit of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Elena Cantone
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive and Odontostomatological Sciences, "Federico II" University Hospital, Naples, Italy
| | - Tiziana Di Cesare
- Unit of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, Rome, Italy
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain
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Ryder CY, Zacharek MA, Welch CM. Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy. Otol Neurotol 2023; 44:462-468. [PMID: 37026811 PMCID: PMC10175161 DOI: 10.1097/mao.0000000000003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To compare the responses of suspected eosinophilic otitis media to treatment with or without a targeted biologic therapy against interleukin-4 (IL-4), IL-5, or IL-13 signaling. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. PATIENTS Subjects with type 2 chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and otitis media who underwent treatment between 2005 and 2021. INTERVENTION Treatment with targeted biologic therapy. MAIN OUTCOME MEASURES Pre- and posttreatment nasal endoscopy, ear examination, and audiologic evaluation. RESULTS Four hundred seventy-seven subjects with type 2 CRSwNP were treated between 2005 and 2021. Sixty-two had otitis media with pre- and posttreatment evaluation. Retrospective chart review assessed pre- and posttreatment exam findings, nasal endoscopy, audiometry, and tympanometry. Nineteen subjects received a biologic therapy, whereas 43 did not. Exam, endoscopy, and tympanometry were graded for severity and compared pre- and posttreatment. Subjective ear exam and tympanometry were significantly improved with biologic therapy (control = 0.05, biologic = 0.84, p = 9.3 × 10 -5 ; control = -0.1, biologic = 0.62, p = 0.0002). Conductive hearing loss as assessed by air-bone gaps did not change between groups (control = 1.2 dB better, biologic = 1.2 dB worse, p = 0.32). Nasal endoscopy findings improved with biologic therapy relative to the control group, although not statistically significant (control = 1.04, biologic = 1.36, p = 0.22). CONCLUSIONS Biologic therapies targeting interleukin-4 (IL-4), IL-5, and IL-13 signaling are potential new treatments for eosinophilic otitis media. This is the largest study demonstrating improvement in subjects with suspected eosinophilic otitis media in response to biologic therapy, and immune modulation represents a novel treatment strategy for this challenging condition. PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED Current treatment strategies for otologic symptoms in eosinophilic disease are not tremendously effective or durable, resulting in a need for improved treatment options. LEARNING OBJECTIVE To determine if targeted biologic therapy, often used for eosinophilic asthma and type 2 chronic rhinosinusitis with nasal polyposis, improves coexistent suspected eosinophilic otitis media. DESIRED RESULT Treatment of suspected eosinophilic otitis media with targeted biologic therapy will result in improvement of otologic symptoms with a durable response compared with current treatment options. LEVEL OF EVIDENCE Level IV. INDICATE IRB OR IACUC Exempt. HUM00182703.
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Affiliation(s)
| | - Mark A. Zacharek
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Christopher M. Welch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Suzaki I, Tanaka A, Yanai R, Maruyama Y, Kamimura S, Hirano K, Kobayashi H. Eosinophilic granulomatosis with polyangiitis developed after dupilumab administration in patients with eosinophilic chronic rhinosinusitis and asthma: a case report. BMC Pulm Med 2023; 23:130. [PMID: 37076824 PMCID: PMC10114392 DOI: 10.1186/s12890-023-02415-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis characterized by eosinophil-rich granulomatous inflammation and small-to-medium vessel vasculitis associated with asthma, rhinosinusitis, and eosinophilia. EGPA is often difficult to distinguish from severe asthma and eosinophilic chronic rhinosinusitis (ECRS) in cases when there are no findings that suggest vasculitis. Dupilumab, an anti-IL-4Rα monoclonal antibody, is expected to be effective in eosinophilic airway inflammatory diseases, such as refractory asthma and chronic rhinosinusitis (CRS). Although transient eosinophilia and eosinophilic pneumoniae have been reported in patients with refractory asthma and CRS associated with dupilumab, few studies have examined the development of EGPA. CASE PRESENTATION We report a case of a 61-year-old woman treated with dupilumab for refractory ECRS and eosinophilic otitis media (EOM) complicated by severe asthma. Although she had a previous history of eosinophilic pneumoniae and myeloperoxidase (MPO) ANCA positivity, there were no apparent findings of vasculitis before the initiation of dupilumab. After the second administration of dupilumab, several adverse events developed, including worsening of ECRS, EOM and asthma, and neuropathy. A blood test showed an eosoinophilia and re-elevation of MPO-ANCA levels after the administration of dupilumab. Therefore, dupilumab was discontinued owing to the development of EGPA, and prednisolone and azathioprine administration was initiated for a remission induction therapy. CONCLUSION To the best of our knowledge, this is the first case report that suggests that dupilumab may directly trigger the manifestation of vasculitis in patients who were previously MPO-ANCA-positive. Although the precise mechanism of how dupilumab could trigger the development of EGPA requires further elucidation, measuring MPO-ANCA in patients with multiple eosinophilic disorders before the initiation of dupilumab might be helpful when considering the possibility of a latent EGPA. When administering dupilumab to patients with a previous history of MPO-ANCA positivity, clinicians must carefully monitor and collaborate with other specialists in the pertinent fields of study for appropriate usage.
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Affiliation(s)
- Isao Suzaki
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan.
| | - Akihiko Tanaka
- Department of Medicine, Division of Respiratory Medicine and Allergology, School of Medicine, Showa University, Tokyo, Japan
| | - Ryo Yanai
- Department of Medicine, Division of Rheumatology, School of Medicine, Showa University, Tokyo, Japan
| | - Yuki Maruyama
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Sawa Kamimura
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Kojiro Hirano
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142-8666, 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] [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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Bartier S, Béquignon E, Thibaut de Ménonville C, Verillaud B, Evrard D, Léger M, Papon JF, Coste A, Taillé C. Otitis media in severe asthma associated with chronic rhinosinusitis with nasal polyps: a new therapeutic target for biologics. J Asthma 2023; 60:139-144. [PMID: 35073225 DOI: 10.1080/02770903.2022.2033262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNPs) is associated with otitis media with effusion (OME) in about 25% of cases. The objective of this study was to assess the clinical efficacy of the 4 biologic agents currently available in France for severe asthma (omalizumab, mepolizumab, benralizumab and dupilumab) in 17 patients followed for both asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) and presenting otitis media with effusion (OME) on otoscopy. Methods: It was a multicenter retrospective study performed in 4 academic ENT and respiratory departments in Paris, France, with assessment of the clinical evolution of 17 patients with severe eosinophilic asthma and with chronic refractory OME and CRSwNPs treated by biologic agents. Global evaluation of treatment effectiveness (GETE) on asthma, CRSwNP and OME was classified on a 5-point scale as 1, excellent; 2, good; 3, moderate; 4, poor; or 5, symptoms worsening. Response was defined as an excellent/good score (1 or 2). Results: 17 patients were prescribed a total of 30 biologics. The evolution of OME did not follow that of asthma and CRSwNPs in 15 (88%) and 12 (70%) cases, respectively. Concerning OME, 19/30 (63%) patients were non-responders. Among the 10 patients who successively received ≥ 2 biologic agents, the OME response differed, depending on the considered agent Dupilumab had the highest response rate. Conclusions: Resistant OME, associated with asthma and chronic rhinosinusitis with nasal polyps, can present a disconnected evolution under biologics. CRSwNP-associated OME requires a specific evaluation to define the best treatment.
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Affiliation(s)
- Sophie Bartier
- Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Service d'ORL et de chirurgie cervico-faciale, AP-HP, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.,Ecole de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France.,INSERM U955, Créteil, France.,CNRS, ERL 7240, Créteil, France
| | - Emilie Béquignon
- Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Service d'ORL et de chirurgie cervico-faciale, AP-HP, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.,Ecole de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France.,INSERM U955, Créteil, France.,CNRS, ERL 7240, Créteil, France
| | - Charlotte Thibaut de Ménonville
- Service de Pneumologie, Hôpital Bichat, AP-HP-Nord, Paris, France.,INSERM U1152, Université de Paris, Paris, France.,INSERM 12, F-CRIN, Clinical Research Initiative in Severe Asthma: A Lever for Innovation & Science (CRISALIS), Toulouse, France
| | - Benjamin Verillaud
- Service ORL et de chirurgie cervico-faciale, Hôpital Lariboisière, AP-HP, Inserm U1141, Université de Paris, Paris, France
| | - Diane Evrard
- Service ORL et de chirurgie cervico-faciale, Hôpital Bichat, APHP, Paris, France
| | - Maëlys Léger
- Service ORL et de chirurgie cervico-faciale, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-François Papon
- INSERM U955, Créteil, France.,CNRS, ERL 7240, Créteil, France.,Service ORL et de chirurgie cervico-faciale, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - André Coste
- Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Service d'ORL et de chirurgie cervico-faciale, AP-HP, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.,Ecole de Médecine, Université Paris-Est Créteil (UPEC), Créteil, France.,INSERM U955, Créteil, France.,CNRS, ERL 7240, Créteil, France
| | - Camille Taillé
- Service de Pneumologie, Hôpital Bichat, AP-HP-Nord, Paris, France.,INSERM U1152, Université de Paris, Paris, France.,INSERM 12, F-CRIN, Clinical Research Initiative in Severe Asthma: A Lever for Innovation & Science (CRISALIS), Toulouse, France
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17
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Iino Y. Eosinophilic otitis media; state-of-the-art diagnosis and treatment. Auris Nasus Larynx 2022:S0385-8146(22)00225-5. [DOI: 10.1016/j.anl.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
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Park HT, Park S, Jung YW, Choi SA. Is Omalizumab Related to Ear and Labyrinth Disorders? A Disproportionality Analysis Based on a Global Pharmacovigilance Database. Diagnostics (Basel) 2022; 12:diagnostics12102434. [PMID: 36292123 PMCID: PMC9600542 DOI: 10.3390/diagnostics12102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Asthma is a chronic disease, characterized by reversible airway obstruction, hypersensitivity reactions, and inflammation. Oral corticosteroids are an important treatment option for patients with severe or steroid-resistant asthma. Biologics for asthma are recommended in patients with severe asthma, owing to their steroid-sparing effect as well as their ability to reduce the severity and aggravation of uncontrolled asthma. Most clinical trials of omalizumab in patients with asthma have suggested its tolerability and safety. However, some studies reported eosinophilic comorbidities in the ear, nose, and throat during omalizumab treatment, particularly eosinophilic otitis media. This study examined the relationship between ear disorders and omalizumab compared with that of other biologics for asthma using a large real-world database. Materials and Methods: Individual case safety reports from the Uppsala Monitoring Centre Vigibase of biologics for asthma (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) up to 29 December 2019, were used. A disproportionality analysis was performed using the proportional reporting ratio (PRR), reporting odds ratio (ROR), and information components (IC). A hierarchy analysis used the Medical Dictionary for Regulatory Activities Terminology. A tree map was generated using R studio version 4.2. Results: In 32,618 omalizumab reports, 714 adverse events (AEs) were detected as signals. Among the 714 signals, seventeen AEs were detected as signals of omalizumab-related ear and labyrinth disorders in 394 reports. Only three AEs (ear pain, ear disorder, and ear discomfort) were detected from mepolizumab. No signal was detected from reslizumab, benralizumab, and dupilumab. Conclusions: Careful monitoring of ear disorders is recommended when omalizumab treatment is started, with decreased oral corticosteroid use in patients with severe asthma. Further studies are necessary to confirm the omalizumab-related signals.
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Affiliation(s)
- Hyeon Tae Park
- College of Pharmacy, Korea University, Sejong Campus, Sejong City 30019, Korea
| | - Sunny Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong Campus, Sejong City 30019, Korea
| | - Yong Woo Jung
- College of Pharmacy, Korea University, Sejong Campus, Sejong City 30019, Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong Campus, Sejong City 30019, Korea
| | - Soo An Choi
- College of Pharmacy, Korea University, Sejong Campus, Sejong City 30019, Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Korea University, Sejong Campus, Sejong City 30019, Korea
- Correspondence: ; Tel.: +82-44-860-1626
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Eosinophilic Otitis Media: Modern Aspects of Pathogenesis, Clinical Features, Diagnosis and Treatment. Indian J Otolaryngol Head Neck Surg 2022; 74:132-140. [PMID: 36032916 PMCID: PMC9411392 DOI: 10.1007/s12070-020-01903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022] Open
Abstract
Eosinophilic otitis media (EOM) is an inflammatory chronic disease of the middle ear, characterized by the presence of a particularly viscous effusion with a high content of protein toxins of eosinophilic origin in the middle ear cavity. The pathology has relationship with bronchial asthma, allergic rhinitis and chronic rhinosinusitis with nasal polyps. EOM is characterized by a sluggish course, a tendency to relapse, which can lead to a gradual hearing decrease up to complete deafness. In this paper, we reviewed the international literature with special attention to pathogenesis and treatment management.
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De Corso E, Settimi S, Montuori C, Corbò M, Passali GC, Porru DP, Lo Verde S, Spanu C, Penazzi D, Di Bella GA, Nucera E, Bonini M, Paludetti G, Galli J. Effectiveness of Dupilumab in the Treatment of Patients with Severe Uncontrolled CRSwNP: A "Real-Life" Observational Study in the First Year of Treatment. J Clin Med 2022; 11:jcm11102684. [PMID: 35628815 PMCID: PMC9146210 DOI: 10.3390/jcm11102684] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/28/2022] [Accepted: 05/07/2022] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to evaluate the efficacy of dupilumab in the treatment of severe uncontrolled Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), with or without asthma as add-on therapy with intra-nasal corticosteroids in a real-life setting over the first year of treatment. Our data demonstrated that subcutaneous 300 mg dupilumab administered at home via a pre-filled auto-injector every two weeks, based on indications set by the Italian Medicines Agency, was rapidly effective in reducing the size of polyps, decreasing symptoms of disease, improving quality of life, and recovering olfaction. Significant improvement was observed after only 15 days of treatment, and it progressively increased at 6 and 12 months. Dupilumab was also effective in reducing the local nasal eosinophilic infiltrate, in decreasing the need for surgery and/or oral corticosteroids, and in improving control of associated comorbidities such as chronic eosinophilic otitis media and bronchial asthma. After 12 months of treatment, 96.5% of patients had a moderate/excellent response. From our data, it was evident that there was a group of patients that showed a very early response within one month of therapy, another group with early response within six months from baseline, and a last group that improved later within 12 months. The results of this study support the use of dupilumab as an effective option in the current standard of care for patients affected by severe uncontrolled CRSwNP.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
| | - Stefano Settimi
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
- Correspondence: ; Tel.: +39-063-015-4149
| | - Claudio Montuori
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Marco Corbò
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Giulio Cesare Passali
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Davide Paolo Porru
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Simone Lo Verde
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Camilla Spanu
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Daniele Penazzi
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Giuseppe Alberto Di Bella
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Eleonora Nucera
- Unit of Allergology, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy;
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Hearth, 00168 Rome, Italy;
| | - Matteo Bonini
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Hearth, 00168 Rome, Italy;
- Unit of Pulmonology, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
| | - Jacopo Galli
- Unit of Otorhinolaryngology—Head and Neck Surgery, A. Gemelli Hospital Foundation IRCCS, 00168 Rome, Italy; (E.D.C.); (G.C.P.); (G.P.); (J.G.)
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy; (C.M.); (M.C.); (D.P.P.); (S.L.V.); (C.S.); (D.P.); (G.A.D.B.)
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Morita S, Nakamaru Y, Fukuda A, Fujiwara K, Suzuki M, Hoshino K, Honma A, Homma A. The Quantification of Extracellular Trap Cell Death-Derived Products as Diagnostic Biomarkers for Otitis Media With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis and Eosinophilic Otitis Media. Otol Neurotol 2022; 43:e337-e343. [PMID: 34802016 DOI: 10.1097/mao.0000000000003431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to quantify the cell-free deoxyribonucleic acid (DNA), citrullinated-histone H3 (cit-H3)-DNA complex, and myeloperoxidase (MPO)-DNA complex as extracellular trap cell death (ETosis)-derived products in the middle ear fluid, and to identify diagnostic biomarkers for the discrimination of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) from eosinophilic otitis media (EOM). STUDY DESIGN Prospective study. SETTING Tertiary referral center. PATIENTS OMAAV patients were eligible for inclusion in this analysis. Patients with EOM were examined as controls. INTERVENTION All samples were obtained from the middle ear fluid in patients with OMAAV or EOM. The fluid samples were aspirated from the middle ear through the anterior-inferior portion of the tympanic membrane using a 1-ml tuberculin syringe with a 24- or 26-gauge needle under a microscope. MAIN OUTCOME MEASURES The levels of cell-free DNA, cit-H3-DNA complex and MPO-DNA complex in the fluid samples were quantified using an enzyme-linked immunosorbent assay. RESULTS Patients with OMAAV showed significantly higher levels of MPO-DNA complex compared to patients with EOM, regardless of the serum ANCA status at the time of sampling (p < 0.001 and p < 0.001, respectively). Meanwhile, there were no significant differences in the values of cell-free DNA or cit-H3-DNA complex between the OMAAV and EOM patients. CONCLUSION The findings of this study suggest that the detection and quantification of MPO-DNA complex in the otitis media fluid can be utilized to discriminate OMAAV, especially in cases of eosinophilic granulomatosis with polyangiitis, from EOM regardless of the serum ANCA status. It should be noted that it is possible for cell-free DNA and cit-H3-DNA complex in fluid samples to be derived from dead cells other than neutrophils that undergo ETosis.
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Affiliation(s)
- Shinya Morita
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Huang VW, Naples J. Eustachian Tube Dysfunction, Eosinophilic Otitis Media, Endolymphatic Hydrops, and the Role of Allergic Rhinitis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Efficacy of Biologics on Refractory Eosinophilic Otitis Media Associated with Bronchial Asthma or Severe Uncontrolled CRSwNP. J Clin Med 2022; 11:jcm11040926. [PMID: 35207196 PMCID: PMC8879230 DOI: 10.3390/jcm11040926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Eosinophilic otitis media (EOM) is a difficult-to-treat otitis media characterized by eosinophilic accumulation in the middle ear mucosa and effusion. It is resistant to conventional treatments and strongly associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). The aim of our study is to evaluate the effectiveness of biologics drugs in the control of EOM. This is a retrospective no-profit real-life observational study, involving patients affected by refractory EOM and in treatment with different biologics for concomitant severe eosinophilic asthma or severe uncontrolled CRSwNP (Dupilumab: n = 5; Omalizumab: n = 1; Mepolizumab: n = 1; Benralizumab: n = 1). We analyzed data at baseline and at the 6-month follow-up, including specific nasal and otological parameters. We observed an improvement of all nasal outcomes, including NPS, SNOT-22, VAS, and smell function. Regarding specific otological parameters, we observed a significant reduction in the mean value of COMOT-15 score and of Otitis Severity Score at 6-month follow-up compared to baseline (p < 0.05). Finally, we observed an improvement in terms of air conduction hearing levels during the treatment. Our results demonstrated that anti type-2 inflammatory pathway biologics can be effective in improving symptoms control and in reducing the severity of eosinophilic otitis media when treating coexisting type-2 diseases, such as asthma and or CRSwNP.
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Matsumoto-Sasaki M, Simizu K, Suzuki M, Suzuki M, Kimura H, Nakamaru Y, Ito YM, Honma A, Konno S. Clinical Characteristics of Patients and Factors Associated with Switching Biologics in Asthma. J Asthma Allergy 2022; 15:187-195. [PMID: 35173450 PMCID: PMC8842638 DOI: 10.2147/jaa.s348513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose Biologics have been used increasingly for the treatment of severe asthma. However, established guidelines for the selection, switching, or discontinuation of biologics do not exist. We aimed to identify the clinical characteristics of patients with asthma who required switching biologics and the factors associated with switching biologics. Patients and Methods This was a retrospective study of 42 patients with severe asthma treated with biologics at the Hokkaido University Hospital between 23rd June 2016 and 30th April 2021, when two biologics were available in Japan. We compared the characteristics of subjects who continued and switched biologics. The time to switch the biologics was assessed by type 2 inflammatory biomarkers, pulmonary function indices, and the presence of comorbidities, including the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score and aspirin exacerbated respiratory diseases (AERD), using the Kaplan–Meier method and a multivariate Cox proportional hazards model. Results Eight and five patients were treated by mepolizumab and benralizumab at baseline, respectively among the 31% (13/42) who switched the biologics. Subjects who required switching biologics were characterized by high blood eosinophil counts, younger age, JESREC scores of 11 points or higher, and AERD. The time taken to switch biologics was significantly shorter in the subgroups with high JESREC scores (≥11) or AERD, compared with their counterparts with low JESREC scores or without AERD (both, P < 0.05). JESREC scores of ≥11, but not the presence of AERD, were associated with time to switch biologics. Conclusion The presence of eosinophilic chronic rhinosinusitis based on JESREC scores of ≥11 and younger age were factors associated with switching biologics in asthma.
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Affiliation(s)
- Machiko Matsumoto-Sasaki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kaoruko Simizu
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Correspondence: Kaoruko Simizu, Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Japan, Tel +81-11-706-5911, Fax +81-11-706-7899, Email
| | - Masanobu Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirokazu Kimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Akihiro Honma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Kikuchi S, Yoshida S, Sugiyama T, Iino Y. A case of eosinophilic otitis media successfully treated by tympanoplasty with use of dupilumab. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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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] [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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Yeo CD, Kim JS, Lee EJ. Association of gastroesophageal reflux disease with increased risk of chronic otitis media with effusion in adults: A nationwide population-based cohort study. Medicine (Baltimore) 2021; 100:e26940. [PMID: 34414952 PMCID: PMC8376319 DOI: 10.1097/md.0000000000026940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/28/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the risk of developing chronic otitis media with effusion (OME) in individuals with gastroesophageal reflux disease (GERD).A retrospective propensity score-matched cohort study was performed using data from the Korea National Health Insurance Service. The GERD group (n = 3532) included certain individuals who had been diagnosed with GERD between January 2002 and December 2005. A comparison control group (n = 14,128) was calculated by 1:4 propensity score matching considering age, sex, and comorbidities and year of enrollment. Each patient was monitored until 2013. Survival analysis, the Log-rank test, and Cox proportional hazard regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of chronic OME for each group.Among the 17,660 individuals included in the study population (53.2% men), the overall incidence of chronic OME during the 11-year follow-up was 1.84-fold higher in the GERD group than in the non-GERD group (1.8 vs 3.0 per 1000 person-year; adjusted HR 1.84; 95% confidence interval [CI], 1.46-2.31). Moreover, the adjusted HRs of developing chronic OME (allergic rhinitis, 1.69 [95% CI, 1.37-2.10]; asthma, 1.29 [95% CI, 1.02-1.64]; chronic rhinosinusitis, 1.61 [95% CI, 1.26-2.05]) were greater in study population with comorbidities.From long-term follow-up, the prevalence of chronic OME in adults was 1.84 times higher in the GERD group compared with the non-GERD group. Specifically, it found that allergic rhinitis, asthma, or chronic rhinosinusitis showed increase the risk of developing chronic OME than those without these conditions.
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Affiliation(s)
- Cha Dong Yeo
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
| | - Jong Seung Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Medical Informatics, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Yeo CD, Kim JS, Lee EJ. Association of gastroesophageal reflux disease with increased risk of chronic otitis media with effusion in adults: A nationwide population-based cohort study. Medicine (Baltimore) 2021; 100:e26727. [PMID: 34398048 PMCID: PMC8294894 DOI: 10.1097/md.0000000000026727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/01/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the risk of developing chronic otitis media with effusion (OME) in individuals with gastroesophageal reflux disease (GERD).A retrospective propensity score-matched cohort study was performed using data from the Korea National Health Insurance Service. The GERD group (n = 3532) included certain individuals who had been diagnosed with GERD between January 2002 and December 2005. A comparison control group (n = 14,128) was calculated by 1:4 Propensity Score (PS) matching considering age, sex, and comorbidities and year of enrolment. Each patient was monitored until 2013. Survival analysis, the log-rank test, and Cox proportional hazard regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of chronic OME for each group.Among the 17,660 individuals included in the study population (53.2% male), the overall incidence of chronic OME during the 11-year follow-up was 1.84-fold higher in the GERD group than in the non-GERD group (1.8 vs 3.0 per 1000 person-year; adjusted HR 1.84; 95% confidence interval [CI], 1.46-2.31). Moreover, the adjusted HRs of developing chronic OME (allergic rhinitis, 1.69 [95% CI, 1.37-2.10]; asthma, 1.29 [95% CI, 1.02-1.64]; chronic rhinosinusitis, 1.61 [95% CI, 1.26-2.05]) were greater in study population with comorbidities.From long-term follow-up, the prevalence of chronic OME in adults was 1.84 times higher in the GERD group compared with the non-GERD group. Specifically, it found that allergic rhinitis, asthma, or chronic rhinosinusitis showed increase the risk of developing chronic OME than those without these conditions.
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Affiliation(s)
- Cha Dong Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
| | - Jong Seung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Medical Informatics, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Takeda M, Sakamoto S, Ueki S, Miyabe Y, Fukuchi M, Okuda Y, Asano M, Sato K, Nakayama K. Eosinophil extracellular traps in a patient with chronic eosinophilic pneumonia. Asia Pac Allergy 2021; 11:e24. [PMID: 34386400 PMCID: PMC8331252 DOI: 10.5415/apallergy.2021.11.e24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023] Open
Abstract
Eosinophils rapidly release extracellular filamentous chromatin fibers (extracellular traps, ETs) when they are stimulated. Reticulated ETs have been recently shown to affect secretion viscosity in eosinophilic inflammatory diseases. Here we report a 43-year-old woman with infiltrative shadows in both upper lungs that did not respond well to antibiotics. She admitted to occasional coughing and sputum, but had poor viscous regulation. Bronchoalveolar lavage fluid (BALF) collected from the upper left lobe showed many eosinophils (65%). She was diagnosed with chronic eosinophilic pneumonia, per previously reported criteria, and began treatment with prednisolone. The infiltration shadow gradually improved, and she was discharged 28 days after admission. Later, we immune-stained her BALF cell components with antibodies against major basic protein, an eosinophil granule protein, which showed a large number of agglomerating eosinophils; and antibodies against citrullinated histone H3 (CitH3-a marker for ETs), which showed CitH3-positive ETs, spread in a network. These findings confirmed that some BALF eosinophils released eosinophil ETs. This case shows the existence of ETs from BALF in patients with chronic eosinophilic pneumonia. Concentration of eosinophil ETs in eosinophilic inflammatory diseases may affect secretion viscosity in sputum, and so on.
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Affiliation(s)
- Masahide Takeda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Sho Sakamoto
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yui Miyabe
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mineyo Fukuchi
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Okuda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mariko Asano
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Sato
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Katsutoshi Nakayama
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
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van der Lans RJL, van Spronsen E, Fokkens WJ, Reitsma S. Complete Remission of Severe Eosinophilic Otitis Media With Dupilumab: A Case Report. Laryngoscope 2021; 131:2649-2651. [PMID: 34216146 PMCID: PMC9292739 DOI: 10.1002/lary.29730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/28/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
Eosinophilic otitis media (EOM) is a difficult‐to‐treat otitis media (OM) characterized by eosinophilic accumulation in the middle ear mucosa and secretion. Associated sensorineural hearing loss can eventually lead to (functional) deafness. EOM is strongly associated with type 2 inflammation driven respiratory disease, i.e. asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), for which biological treatment is available. This case report discusses a patient suffering from EOM with severe mixed hearing loss, nearing functional deafness. Dupilumab treatment resulted in complete and enduring remission of the EOM, enabling adequate hearing rehabilitation. Concurrent control of the comorbid asthma and CRSwNP was obtained. Laryngoscope, 131:2649–2651, 2021
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Affiliation(s)
- Rik J L van der Lans
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik van Spronsen
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wytske J Fokkens
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sietze Reitsma
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Cycling therapy with benralizumab and dupilumab for severe eosinophilic asthma with eosinophilic chronic rhinosinusitis and eosinophilic otitis media. Allergol Int 2021; 70:389-391. [PMID: 33685801 DOI: 10.1016/j.alit.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/25/2021] [Accepted: 02/04/2021] [Indexed: 01/16/2023] Open
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Esu Y, Tamii S, Masuda M, Iino Y, Yoshida N. Effectiveness of myringoplasty in patients with eosinophilic otitis media. Auris Nasus Larynx 2021; 48:368-376. [DOI: 10.1016/j.anl.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022]
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Chen T, Ashman PE, Bojrab DI, Johnson AP, Hong RS, Benson B, Svider PF. Diagnosis and management of eosinophilic otitis media: a systematic review. Acta Otolaryngol 2021; 141:579-587. [PMID: 33825596 DOI: 10.1080/00016489.2021.1901985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Eosinophilic Otitis Media (EOM) is a relatively newly defined entity of recurrent and resistant otitis media. OBJECTIVE To perform a systematic review of otologic manifestations, diagnosis and management of eosinophilic otitis media (EOM). METHODS 393 patients diagnosed with EOM of 26 studies met inclusion criteria and were assessed for demographics, otologic manifestations, diagnostic criteria fulfilled, and medical and surgical treatments. RESULTS Most common otologic manifestations were hearing loss (65%), otitis media with effusion (16%), tympanic membrane perforation (13%), and otorrhea (13%). 93% had a predominantly eosinophilic middle ear effusion, 95% had asthma, 85% had a highly viscous middle ear effusion, 71% had nasal polyposis, and 58% had resistance to conventional treatment. For treatment, 39% received intratympanic steroid injections, 33% received systemic steroids, 17% received steroid ear drops and 13% received a biological agent. 39% of patients underwent a surgical intervention with 26% receiving functional endoscopic sinus surgery and 18% receiving myringotomy with tube insertion. Success rates were highest with use of intratympanic steroids (45%), systemic steroids (26%), and biological agents (58%). CONCLUSION Intratympanic steroids show the most efficacy in treating EOM, and aggressive optimization of asthma may be beneficial in resolving otologic symptoms. Surgery should be reserved for refractory cases and complications.
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Affiliation(s)
- Tiffany Chen
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ, USA
| | - Peter E. Ashman
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Andrew P. Johnson
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Robert S. Hong
- Michigan Ear Institute, Farmington Hills, MI, USA
- Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brian Benson
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
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Abstract
PURPOSE OF REVIEW Eosinophilic otitis media (EOM) is an intractable otitis media characterized by numerous eosinophils infiltrating the middle ear cavity, which is part of the upper airway. EOM shows a high rate of comorbidity with asthma. They are considered to have a 'one airway, one disease' relationship. Here, we summarize our current knowledge regarding the characteristics of EOM, EOM's relationship with asthma and the efficacy of optimal treatments for EOM. RECENT FINDINGS The greater the severity of asthma, the more pronounced the development of EOM. Asthma control is usually inadequate in asthmatics who develop EOM, and appropriate strengthening of asthma inhalation therapy leads to improvement in the EOM. EOM severity can be divided into mild, moderate, and severe. Intratympanic infusion therapy using a topical steroid such as triamcinolone acetone is effective for mild EOM, whereas moderate EOM requires a systemic steroid in addition to triamcinolone acetone, and severe EOM forms granulation tissue that requires surgical removal. Recently, the effectiveness of molecularly targeted drugs is being reported, but more data need to be accumulated. SUMMARY EOM and asthma are closely related. Optimal asthma treatment is important for treating EOM. Treatments commensurate with the severity of EOM are being developed.
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Thorsberger M, Porsbjerg C, Yde J, Aanaes K. Effects on hearing and tinnitus following Dupilumab treatment of severe asthma with chronic rhinosinusitis - a case report. RHINOLOGY ONLINE 2021. [DOI: 10.4193/rhinol/21.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Dupilumab (anti-IL-4R) is a novel biological agent approved for treatment of severe asthma with chronic rhinosinusitis. Beneficial effects on hearing have only been sparsely decribed. Case presentation: In this case story we present a 48-year woman, who experienced remarkably improved hearing and reduction of tinnitus after initiation of Dupilumab. Progress was monitored by respiratory physicians in collaboration with rhinologists and audiologists. SNOT-22 score improved from 83 to 27 and audiograms obtained before and during treatment illustrate a reduced air-bone gap and an improvement of speech recognition threshold from 25 dB (both ears) to 15 and 10 (left and right ear respectively). Conclusions: This case story implies a beneficial effect of Dupilumab treatment in patients with united airway disease with hearing impairment. The authors suggest an additional otological perspective in addition to standard monitoring.
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Use of IL-5 Inhibitor Benralizumab as a Novel Therapy for Eosinophilic Otitis Media: Clinical Capsule and Review of Literature. Otol Neurotol 2021; 41:e238-e240. [PMID: 31923159 DOI: 10.1097/mao.0000000000002493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We report a case of recurrent eosinophilic otitis media (EOM) successfully treated with the novel monoclonal IL-5 inhibitor benralizumab. We also review literature relevant to EOM diagnosis and potential for biologic treatment. PATIENT A 24-year-old woman with bilateral otitis media with effusion unresponsive to standard treatment. INTERVENTION(S) Multidisciplinary treatment using subcutaneous benralizumab after diagnosis of EOM. MAIN OUTCOME MEASURE(S) Behavioral audiometry, peripheral serology, otomicroscopy, and eosinophilic otitis media symptom severity. RESULTS Recalcitrant otitis media with effusion (OME) in the setting of nasal polyposis and asthma prompted clinical suspicion for EOM, which was confirmed by pathologic examination of middle ear effusion and soft tissue biopsy. Treatment with benralizumab was initiated by pulmonology and well-tolerated. Within 2 months of treatment onset there was a cessation of EOM symptoms, a reduction of peripheral eosinophil levels, and an improvement in conductive hearing loss. CONCLUSIONS Monoclonal antibodies such as benralizumab may be an effective treatment option for EOM. A high level of clinical suspicion in patients with bronchial asthma, nasal polyposis, and recalcitrant OME may allow early diagnosis of EOM. Awareness of emerging biologic treatment options is important in the management of this challenging entity and may prevent long-term sequelae.
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Brandt HH, Metternich FU, Fürer R. Chronic otorrhoea, otalgia and hearing loss not responding to antibiotics and tympanoplasty surgery. BMJ Case Rep 2021; 14:14/4/e240897. [PMID: 33811095 PMCID: PMC8023633 DOI: 10.1136/bcr-2020-240897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic otorrhoea from a tympanic membrane perforation is common. We present the case of a patient who had already received seemingly adequate treatment for his condition in the past. Yet, he presented to our outpatient clinic with worsening otalgia and otorrhoea, progressive hearing loss and a new tympanic membrane perforation. After a thorough otological evaluation, the patient's medical history and the histological specimen from a previous operation were reviewed. The findings met the diagnostic criteria of eosinophilic otitis media. After treatment with topic triamcinolone through the perforated tympanic membrane, the patient's otalgia subsided, hearing levels were improved and the size of the tympanic membrane perforation decreased.
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Affiliation(s)
| | | | - Raffaela Fürer
- Department of Otolaryngology, Kantonsspital Aarau AG, Aarau, Switzerland
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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: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [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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Breslin NK, Heindel NH, Haberman RS. Role of Interleukin 5 Inhibition in the Treatment of Eosinophilic Otitis Media. OTO Open 2021; 5:2473974X21991449. [PMID: 33598601 PMCID: PMC7863164 DOI: 10.1177/2473974x21991449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Eosinophilic otitis media (EOM) is a rare form of middle ear disease characterized by a viscous effusion rich in eosinophils, a resistance to conventional treatments, and an association with bronchial asthma. The relationship between asthma and EOM suggests similarities in pathogenesis and treatment possibilities. Recent biologic therapies, specifically those that target interleukin 5 (IL-5), have demonstrated efficacy in controlling eosinophil-driven asthma, yet their impact on the treatment of pathologically similar diseases remains unmeasured. This study identifies patients who have EOM, reviews their otologic clinical course, and investigates the impact of anti-IL-5 drugs on chronic ear disease. Study Design Retrospective chart review. Setting University of Florida Health, an academic medical center. Methods A review of 120 patients treated with benralizumab or mepolizumab was performed. Imaging evidence of otomastoiditis was used to identify 9 patients with possible EOM. Two patients were treated with benralizumab, and the remaining 7 received mepolizumab injections. Results After starting treatment, 5 patients had complete resolution of middle ear effusions (3 with mepolizumab and 2 with benralizumab); 1 had stable middle ear effusion; and 1 patient’s disease status could not be determined due to a lack of follow-up. The remaining 2 patients did not have effusions at the time when anti-IL-5 therapy was initiated, and they have not relapsed since starting treatment. Conclusion EOM is a rare disease that otolaryngologists should include in their differential diagnosis, especially in refractory cases. Anti-IL-5 agents show efficacy in treating EOM, and prospective multicenter clinical trials are needed to further characterize the effect of anti-IL-5 therapies.
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Affiliation(s)
| | - N Hadley Heindel
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Rex S Haberman
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
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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] [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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Hara R, Kudo N, Suzuki S, Miura T, Matsubara A. CD11c(+) dendritic cells coexpressing thymic stromal lymphopoietin receptor in animal model of eosinophilic otitis media. Asia Pac Allergy 2020; 10:e41. [PMID: 33178566 PMCID: PMC7610081 DOI: 10.5415/apallergy.2020.10.e41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background Eosinophilic otitis media (EOM) is an intractable middle ear disease often associated with eosinophilic inflammatory airway conditions. Recently, dendritic cells (DCs) have been indicated as an essential component of Th2 allergic inflammation, such as bronchial asthma. DCs are activated by thymic stromal lymphopoietin (TSLP), an epithelial cell-derived cytokine. However, the relationship between TSLP and DCs in EOM remains unknown. Objective This study aimed to investigate the relationship between DCs and TSLP and to determine the involvement of DCs in EOM in an animal model. Methods Hartley guinea pigs were used as the animal model. Daily ovalbumin (OVA) stimulation of the middle ear was performed for 7 or 14 days. The temporal bone was dissected on the last day of stimulation, and paraffin-embedded sections were prepared. Immunostaining and immunofluorostaining for TSLP receptor (TSLPR) and CD11c, a surface marker of DCs, were performed. Results We found CD11c-immunopositive cells in the submucosal area of the middle ear epithelium, particularly around the eustachian tube. TSLPR-immunopositive cells exhibited a similar distribution as CD11c-positive cells. Conclusion CD11c positive DCs coexpressing TSLPR were recruited after OVA challenge which might activate Th2 allergic reaction.
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Affiliation(s)
- Ryutaro Hara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naomi Kudo
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoshi Suzuki
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoya Miura
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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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: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [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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Risk factors for bacterial infection to cause sensorineural hearing loss in eosinophilic otitis media. Auris Nasus Larynx 2020; 48:207-213. [PMID: 32883575 DOI: 10.1016/j.anl.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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] [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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Harabuchi Y, Kishibe K, Tateyama K, Morita Y, Yoshida N, Okada M, Kunimoto Y, Watanabe T, Inagaki A, Yoshida T, Imaizumi M, Nakamura T, Matsunobu T, Kobayashi S, Iino Y, Murakami S, Takahashi H, Tono T. Clinical characteristics, the diagnostic criteria and management recommendation of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) proposed by Japan Otological Society. Auris Nasus Larynx 2020; 48:2-14. [PMID: 32768313 DOI: 10.1016/j.anl.2020.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a form of necrotizing vasculitis with few or no immune deposits. It primarily affects small and medium blood vessels. AAV is classified into three categories, granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangitis (EGPA), and two major ANCAs, proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA are involved in their pathogenesis. Intractable otitis media frequently occurs in patients with GPA, MPA or EGPA, although all patients show similar clinical features, regardless of the type of AAV. Furthermore, approximately 15% patients with otitis media caused by AAV do not show ANCA positivity, histopathological evidence, or any other AAV-related lesions at the initial visit; therefore, these patients do not fulfill the ordinary diagnostic criteria for systemic AAV. Thus, we first proposed that this condition could be categorized as "otitis media with AAV (OMAAV)". Subsequently, the Japanese Otological Society (JOS) conducted a nationwide survey between December 2013 and February 2014 and identified 297 patients with OMAAV. The survey revealed that OMAAV is a disease that initially occurs in the middle ear and subsequently spreads to other organs such as the lungs and kidneys, with eventual involvement of all body organs. Severe sequelae such as facial palsy, hypertrophic pachymeningitis, complete deafness, and subarachnoid hemorrhage resulting in death can also occur. In this review, we introduce the clinical features, diagnostic criteria, and treatment strategies recommended by JOS for early diagnosis and treatment of OMAAV.
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Affiliation(s)
- Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, , Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido, Japan.
| | - Kan Kishibe
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, , Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido, Japan
| | - Kaori Tateyama
- Department of Otolaryngology, Oita University Faculty of Medicine, Oita, Japan
| | - Yuka Morita
- Department of Otolaryngology, Niigata University Faculty of Medicine, Niigata, Japan
| | - Naohiro Yoshida
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Omiya, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Ehime University Faculty of Medicine, Toon, Japan
| | - Yasuomi Kunimoto
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Takeshi Watanabe
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Akira Inagaki
- Department of Neuro-otolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Nakamura
- Department of Otolaryngology, Miyazaki University Faculty of Medicine, Miyazaki, Japan
| | | | - Shigeto Kobayashi
- Department of Internal Medicine, Juntendo University Koshigaya Hospital, Koshigaya, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Omiya, Japan
| | - Shingo Murakami
- Department of Neuro-otolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Haruo Takahashi
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Tetsuya Tono
- Department of Otolaryngology, Miyazaki University Faculty of Medicine, Miyazaki, Japan
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Varghese L, Philip A, Suryawanshi MK, Job A. Eosinophilic Otitis Media-An Otitis Media Mandating a Different Outlook. EAR, NOSE & THROAT JOURNAL 2020; 101:83-85. [PMID: 32744905 DOI: 10.1177/0145561320947269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lalee Varghese
- Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajay Philip
- Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mayur K Suryawanshi
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anand Job
- Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
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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] [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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Differentiation Between Eosinophilic Otitis Media and Otitis Media Associated With Eosinophilic Granulomatosis With Polyangiitis. Otol Neurotol 2020; 40:e796-e802. [PMID: 31290803 DOI: 10.1097/mao.0000000000002295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform comparisons and clarify differences in clinical manifestations between eosinophilic otitis media (EOM) and otitis media associated with eosinophilic granulomatosis with polyangiitis (EGPA). STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Twenty-two ears of 11 patients exhibiting EOM (EOM group) and 20 ears of 12 patients exhibiting otitis media associated with EGPA (EGPA group). MAIN OUTCOME MEASURES Otological manifestations, nasal and paranasal manifestations, incidence of asthma, positivity for serum antineutrophil cytoplasmic antibodies (ANCA), total serum immunoglobulin (Ig) E level, peripheral blood eosinophil fraction, and hearing outcomes. RESULTS The incidence and age of onset of asthma and chronic rhinosinusitis were comparable between the EOM and EGPA groups. Moreover, otological findings and hearing outcomes at the initial visit were similar in both groups. Computed tomography images of the paranasal sinus showed predominant opacification of the ethmoid sinus in both groups. Although the total serum IgE level was not significantly different, the peripheral blood eosinophil fraction was significantly larger in the EGPA group than in the EOM group (p = 0.0035). Furthermore, the rate of myeloperoxidase-antineutrophil cytoplasmic antibodies (ANCA) positivity was significantly higher in the EGPA group than in the EOM group (p = 0.019). CONCLUSIONS The findings of the present study suggest that the phenotypic characteristics of EOM closely resemble those of otitis media associated with EGPA in early stages before the appearance of vasculitis. Therefore, it is challenging to differentiate the two conditions purely on the basis of otorhinological examinations.
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Han YE, Kang YS, Cho Y, Park MK. Eosinophilic Otitis Media Treated with Anti-IgE Monoclonal Antibodies and A Bone Conduction Implant. J Int Adv Otol 2019; 14:144-147. [PMID: 29764789 DOI: 10.5152/iao.2018.4517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Eosinophilic otitis media (EOM) are intractable otitis media characterized by highly viscous secretions containing eosinophils in the middle ear. They are resistant to conventional medication and surgery. This condition occurs primarily in patients with bronchial asthma or allergic rhinitis and is often complicated by rhinosinusitis. Systemic and topical steroid therapies are effective treatments. However, long-term steroid therapy is often limited by a high risk of serious adverse effects. The use of topical steroids and otorrhea are bothersome when wearing hearing aids. Here, we report a case of intractable otitis media due to EOM. Otorrhea was controlled with topical steroids. Bone conduction hearing was stable for an extended period with anti-IgE monoclonal antibodies (omalizumab). An implantable bone conduction hearing aid was used for rehabilitation of conductive hearing loss.
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Affiliation(s)
- Young Eun Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Yong Seok Kang
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Younhoon Cho
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University School of Medicine, Seoul, Republic of Korea
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Hypereosinophilic syndrome presenting with bilateral ear fullness. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:199-201. [DOI: 10.1016/j.anorl.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 02/03/2023]
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