International Journal of Pediatric Otorhinolaryngology
Allergic diseases in children with otitis media with effusion☆
Introduction
Otitis media with effusion (OME) is the most prevalent ear disease in children and is a common cause of hearing impairment. The prognosis of most patients is good, but 10% of children have recurrent and/or persistent OME. Because recurrent/persistent OME may cause complications, including impaired hearing and language development and behavior disorders, surgical interventions, such as ventilation tube insertion, may be necessary [1], [2].
Among the host factors associated with the onset of OME are bacterial infections, Eustachian tube dysfunction, allergic and immunologic factors, genetic factors, breast feeding, gender, and race. OME may also be associated with environmental factors, including communal living and unhygienic habits, and anatomical and physiologic factors, including cleft palate and Down syndrome, which often accompany Eustachian tube dysfunction [3].
Recent guidelines from otologists, pediatricians, and allergists based on clinical evidence support the role of atopy in the development of OME. The involvement of IgE mediated allergic reactions in the pathogenesis of OME has been suggested by clinical observations of a high prevalence of OME among patients with allergies [4]. The important role of allergy in the genesis and recurrence of OME is also supported by data literature that evidence a statistically significant differences in audiological characteristics among atopic and non atopic subjects suffering from OME. In fact in atopic children it found a predominance of bilateral OME and a higher hearing impairment [5], [6]. Indeed, the combination of antibiotics and anti-allergy agents has been shown to be more effective than antibiotics alone in patients with allergy and OME [7] and in patients with Eustachian tube occlusion caused by more severe purulent effusion [8]. Therefore, determining whether patients with persistent or recurrent OME also have allergic disorders is important prior to the commencement of treatment. Among the various types of allergic diseases are allergic rhinitis, asthma, allergic conjunctivitis and atopic dermatitis. Most studies have assessed the relationship between allergic rhinitis and otitis media, with fewer studies evaluating the association between OME and other allergic diseases.
We therefore assessed the relationship between OME and allergic diseases and other types of disease in children who had undergone ventilating tube insertion due to a poor response to conservative management of OME for more than 3 months. We also evaluated the between group differences in the characteristics of middle ear effusion.
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Patients
The medical chart of 370 patients, aged 1–14 years (mean 7.5 years), who had been diagnosed with OME at ENT clinics between January 2007 and December 2011 were retrospectively reviewed. As a control group, we selected 100 children aged 3–12 years (mean age, 6.3 years) with no medical history of OME and no history of otitis media on physical examination and audiometry, but who had undergone blood tests and MAST-CLA (multiple allergosorbent test – chemiluminescent assay) due to ankyloglossia,
Results
Of the 370 patients with OME, 125 (33.8%) had allergic rhinitis (AR), 8 (2.2%) had asthma, 10 (2.7%) had atopic dermatitis (AD), 2 (0.5%) had allergic conjunctivitis (AC) and 27 (7.3%) had chronic rhinosinusitis (CRS). Of the control group of 100 patients without OME, 16 (16.0%) had AR, 8 (8.0%) had asthma, 3 (3.0%) had AD, and 4 (4.0%) had AC and CRS. The two groups differed significantly only in the incidence of AR (p < 0.05) (Table 1).
We also found that the rates of tonsil and adenoid
Discussion
OME is caused by the accumulation of fluid in the middle ear cavity without acute symptoms, such as fever or otalgia, and may develop secondary to acute otitis media or other causes without infection. In the first year of life, more than 50% of children will experience OME, and the percentage increases to greater than 60% by age 2 years. Many episodes resolve spontaneously within 3 months, but about 30–40% of children have recurrent OME, and 5–10% of episodes last 1 year or longer [11]. However
Conclusion
We found that the rate of allergic rhinitis was significantly higher among pediatric patients with than without OME, although the rates of other allergic diseases did not differ in these two groups. The likelihoods of allergic rhinitis and asthma were higher in patients with serous than with mucous MEE.
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This research was supported by the Kyung Hee University Research Fund in 2011 (KHU-2011-1098).
- 1
Both the authors contributed equally to this work.
- 2
Current address: Department of Otolaryngology, School of Medicine, Eulji University, Daejeon, Republic of Korea.