тел. +38 (044) 483-12-82

№5(8) 2025

Укр

DOI 10.37219/2528-8253-2025-5-72

Pukhlik SM, Titarenko OV
EOSINOPHILIC OTITIS MEDIA. WHAT IS THIS DISEASE?
Pukhlik Sergey M
Odessa National Medical University
Head of the Department of Otorhinolaryngology
Doctor of Medical Sciences, Professor
E-mail: lor@te.net.ua
Orchid ID: http://orcid.org/0000-0001-7196-9642
Scopus Author ID: 6506298353
Titarenko Olga V
Odessa National Medical University
Department of Otorhinolaryngology
Associate Professor
Candidate of Medical Sciences
e-mail: otit3333@gmail.com
ORCID ID: https://orcid.org/0000-0002-6024-0757

Abstract

Purpose of the study: Allergists, immunologists, and otorhinolaryngologists are actively discussing about inclusion “Eosinophilic otitis media” in the list of human allergic diseases as a separate nosoform, since it differs significantly from other allergic ear lesions in etiology, clinical manifestations, and, above all, treatment tactics.

Materials and methods: A probing analysis of literature data, as well as our own observations regarding the specific signs of eosinophilic otitis media, was conducted, and the main diagnostic, clinical, and laboratory criteria were determined. A clinical case of ESO is provided.

Results: It has been found that eosinophilic otitis media occurs in patients with bronchial asthma and nasal polyposis. IgE-mediated allergy is found in some patients, but is not a universal mechanism. This pathology is considered as an eosinophilic inflammatory disease, and not as a typical secretory otitis media. Treatment is based on the use of local and systemic glucocorticosteroids. An algorithm of diagnostic and therapeutic approaches has been developed and provided for discussion.

Conclusions: Eosinophilic otitis media is a distinct nosological form that is closely related to eosinophilic inflammatory diseases of the respiratory tract. It is considered a Th2 inflammatory disease because middle ear secretions contain numerous eosinophils and high concentrations of type 2 inflammatory biomarkers such as IgE, eosinophilic cationic protein, and IL-5. Further studies should be aimed at clarifying the different phenotypes and endotypes of eosinophilic otitis media and at developing treatment strategies, including the use of biologics medicines.

Keywords: eosinophilic inflammation, otitis mediа, hearing impairment, nasal polyposis, bronchial asthma.

Download.PDF

References

  1. Koch H. Allergical investigations of Chronic otitis. Acta Otolaryngol. 1947;Suppl 62:1-201.
  2. Tomioka S, Yuasa R, Iino Y: Intractable otitis media in cases with bronchial asthma. In Recent Advances in Otitis Media: Proceedings of the Second Extraordinary International Symposium on Recent Advances in Otitis Media. Edited by Mogi G, Honjo I, Ishii T, et al.: Amsterdam/New York: Kugler Publications; 1993:183-186.
  3. Tomioka S, Kobayashi T, Takasaka T. Intractable otitis media in patients with bronchial asthma (eosinophilic otitis media). In: Sanna M, editor. Cholesteatoma and mastoid surgery. Rome: CIC Edizioni Internazionali; 1997: 851-853.
  4. Mogi G, Suzuki M. The Role of IgE-mediated Immunity in Otitis Media: fact or Fiction? Ann N Y Acad Sci. 1997 Dec 29:830:61-9. doi: 10.1111/j.1749-6632.1997.tb51879.x.
  5. Derlacki E.L. Aural manifestations of allergy. Ann Otol Rhinol Laryngol. 1952 Mar;61(1):179-88. doi: 10.1177/000348945206100116.
  6. Tomonaga K, Kurono Y, Mogi G. The role of nasal allergy in otitis media with effusion. A clinical Study. Acta Otolaryngol Suppl. 1988:458:41-7. doi: 10.3109/00016488809125100.
  7. Morinaka S. Allergic otitis media with geratinous mucoid fluid containing eosinophils. Otolaryngol Head Neck Surg. 1996 Apr;114(4):665-8. doi: 10.1016/S0194-59989670267-X.
  8. Yukiko I, Tomioka-Matsutani S, Matsubara A, Nakagawa T, Nonaka M. Diagnostic criteria of eosinophilic otitis media, a newly recognized middle ear disease. Auris Nasus Larynx. 2011 Aug;38(4):456-61. doi: 10.1016/j.anl.2010.11.016.
  9. Hurst DS, Fredens K. Eosinophil cationic protein in mucosal biopsies from patients with allergy and otitis media with effusion. Otolaryngol Head Neck Surg. 1997 Jul;117(1):42-8. doi: 10.1016/S0194-59989770204-3.
  10. Suzuki H, Matustani S, Kawase T, Iino Y, Kawauchi H, Gyo K. Epidemiologic Surveillance of “eosinophilic otitis media” in Japan. Otol Jpn. 2004;14(2):112-117. doi: 10.11289/otoljpn1991.14.112
  11. Chen T, Ashman PE, Bojrab DI 2nd, Johnson AP, Hong RS, Benson B, Svider PF. Diagnosis and management of eosinophilic otitis media: a systematic review. Acta Otolaryngol. 2021 Jun;141(6):579-587. doi: 10.1080/00016489.2021.1901985.
  12. Kanazawa H, Yoshida N, Yamamoto H, Hara M, Hasegawa M, Matsuzawa S, et al. Risk factors associated with severity of eosinophilic otitis media. Auris Nasus Larynx. 2014 Dec;41(6):513-7. doi: 10.1016/j.anl.2014.08.003
  13. Tokunaga T, Sakashita M, Haruna T, Asaka D, Takano S, Ikeda H, et al. Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC study. Allergy. 2015 Aug;70(8):995-1003. doi: 10.1111/all.12644.
  14. Iino Y. Еosinophilic otitis media: A new middle ear disease. Curr Allergy Asthma Rep. 2008 Nov;8(6):525-30. doi: 10.1007/s11882-008-0096-5.
  15. Masuda M, Esu Y, Iino Y, Yoshida N. Risk factors for bacterial infection to cause sensorineural hearing loss in eosinophilic otitis media. Auris Nasus Larynx. 2021 Apr;48(2):207-213. doi: 10.1016/j.anl.2020.08.001.
  16. Nakagawa T, Matsubara A, Shiratsuchi H, Kakazu Y, Nakashima T, Koike K, et al. Intractable otitis media with eosinophils: importance of diagnosis and validity of treatment for hearing preservation. ORL J Otorhinolaryngol Relat Spec. 2006;68(2):118-22. doi: 10.1159/000091215.
  17. Nishizawa H, Matsubara A, Nakagawa T, Ohta N, Izuihara K, Shirasaki T, et al. The role of periostin in eosinophilic otitis media. Acta Otolaryngol. 2012 Aug;132(8):838-44. doi: 10.3109/00016489.2012.668708.
  18. Fahy JV, Dickey BF. Airway mucus function and dysfunction. N Engl J Med. 2010 Dec 2;363(23):2233-47. doi: 10.1056/NEJMra0910061.
  19. Ueki S, Y Konno, M Takeda, Y Moritoki, M Hirokawa, Y Matuwaki, et al. Eosinophil extracellular trap cell death-derived DNA traps: Their presence in secretions and functional attributes. J Allergy Clin Immunol. 2016 Jan;137(1):258-267. doi: 10.1016/j.jaci.2015.04.041.
  20. Nagase H. Severe asthma in Japan. Allergol Int. 2019 Apr;68(2):167-171. doi: 10.1016/j.alit.2019.02.004.
  21. Fukuda A, Morita S, Nakamaru Y, Hoshino K, Fujiwara K, Homma A. Differentiation between eosinophilic otitis media and otitis media associated with eosinophilic granulomatosis with polyangiitis. Otol Neurotol. 2019 Sep;40(8):e796-e802. doi: 10.1097/MAO.0000000000002295.
  22. Jung HJ, Yu GH, Park JH. Hypereosinophilic syndrome presenting with bilateral ear fullness. Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Jun;136(3):199-201. doi: 10.1016/j.anorl.2018.03.009.
  23. Esu Y, Iino Y, Masuda M, Kanazawa H, Yoshida N. Proposal of a treatment strategy for eosinophilic otitis media based on middle ear condition. Otol Neurotol. 2018 Sep;39(8):e671-e678. doi: 10.1097/MAO.0000000000001912.
  24. Esu Y, Masuda M, Yoshida Y. Periostin in middle ear mucosa according to eosinophilic otitis media severity: middle ear pathology-based treatment. Auris Nasus Larynx. 2020 Aug;47(4):527-535. doi: 10.1016/j.anl.2020.05.014.
  25. Izuhara K, Nunomura S, Nanri Y, Ono J, Takai M, Kawaguch A.. Periostin: An emerging biomarker for allergic diseases. Allergy. 2019 Nov;74(11):2116-2128. doi: 10.1111/all.13814.
  26. Iino Y, Hara M, Hasegawa M, Matsuzawa S, Shinnabe A, Kanazawa H, et al. Clinical efficacy of anti-IgE therapy for eosinophilic otitis media. Otol Neurotol. 2012 Sep;33(7):1218-24. doi: 10.1097/MAO.0b013e318263d5b8.
  27. Iino Y, Sekine Y, Yoshida S, Kikuchi S. Dupilumab therapy for patients with refractory eosinophilic otitis media associated with bronchial asthma. Auris Nasus Larynx. 2021 Jun;48(3):353-360. doi: 10.1016/j.anl.2020.09.001.
  28. Lund VJ, Kennedy DW. Staging for Otolaryngol Head Neck Surg. 1997 Sep;117(3 Pt 2):S35-40. doi: 10.1016/S0194-59989770005-6.
  29. Matsubara A, Takahata J, Miura T, Kudo N. Treatment of eosinophilic otitis media. J Clin Cell Immunol. 2018;9(1):538. doi: 10.4172/2155-9899.1000538.
  30. Seo Y, Nonaka M, Yamamura Y, Pawankar R, Tagaya E. Optimal control of asthma improved eosinophilic otitis media. Asia Pac Allergy. 2018 Jan 24;8(1):e5. doi: 10.5415/apallergy.2018.8.e5
  31. Iino Y, Nagamine H, Kakizaki K, Komiya T, Katano H, Saruya S, et al. Effectiveness of instillation of triamcinolone acetonide into the middle ear for eosinophilic otitis media associated with bronchial asthma. Ann Allergy Asthma Immunol. 2006 Dec;97(6):761-6. doi: 10.1016/S1081-1206(10)60967-2.
  32. Matsubara A, Kuroda R, Usami S, Takahata J, Shinkawa H. The effect of topical administration of heparin to the eosinophilic otitis media. In: Recent advances in otitis media. Bologna: Monduzzi Editore; 2001: 403-406.
  33. Kikuchi S, Sekine Y, Yoshida S, Iino Y. Clinical course of patients with eosinophilic otitis media treated by intensive care. Otol Jpn. 2020;30(1):29-35. https://doi.org/10.11289/otoljpn.30.29.
  34. Iino Y, Kakizaki K, Saruya S, Katano H, Komiya T, Kodera K, et al. Eustachian tube function in patients with eosinophilic otitis media. Arch Otolaryngol Head Neck Surg. 2006 Oct;132(10):1109-14. doi: 10.1001/archotol.132.10.1109.
  35. 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. Nov 2021;21. Article 100381. https://doi.org/10.1016/j.xocr.2021.100381.
  36. Iwasaki S, Nagura M, Mizuta K. Cochlear implantation in a patients with eosinophilic otitis media. Eur Arch Otorhinolaryngol. 2006 Apr;263(4):365-9. doi: 10.1007/s00405-005-1006-2.
  37. Kojima H, Sakurai Y, Rikitake M, Tanaka Y, Kawano A, Moriyama H. Cochlear implantation in patients with chronic otitis media. Auris Nasus Larynx. 2010 Aug;37(4):415-21. doi: 10.1016/j.anl.2010.01.009.
  38. Magliocca K, Vivas EX, Griffith CC. Idiopathic, infectious and reactive lesions of the ear and temporal bone. Head Neck Pathol. 2018 Sep;12(3):328-349. doi: 10.1007/s12105-018-0952-0.
  39. Popovych VI, Orishchak [State of hearing function and eustachian tonsils in patients with secretory otitis media at different stages of its development]. Art of Medicine. 2022;24(4):142-48. doi: 10.21802/artm.2022.4.24.142. [Article in Ukrainian].
  40. Nomenclature of allergic diseases and hypersensitivity reactions: adaptation to modern needs. Position paper of the European Academy of Allergy and Clinical Immunology (EAACI). Klinichna immunolohiia. Alerholohiia. Infektolohiia. 2024;153(4):20-26. [Article in Ukrainian]. Available from: https://kiai.com.ua/uploads/issues/2024/4(153)/kiai24_4_20-26.pdf.