ASSOCIATION OF OTITIS-MEDIA WITH EFFUSION AND ALLERGY AS DEMONSTRATEDBY INTRADERMAL SKIN TESTING AND EOSINOPHIL CATIONIC PROTEIN-LEVELS INBOTH MIDDLE-EAR EFFUSIONS AND MUCOSAL BIOPSIES
Ds. Hurst, ASSOCIATION OF OTITIS-MEDIA WITH EFFUSION AND ALLERGY AS DEMONSTRATEDBY INTRADERMAL SKIN TESTING AND EOSINOPHIL CATIONIC PROTEIN-LEVELS INBOTH MIDDLE-EAR EFFUSIONS AND MUCOSAL BIOPSIES, The Laryngoscope, 106(9), 1996, pp. 1128-1137
This study was performed to ascertain the role of allergy, as defined
by skin testing and histochemical markers, in the pathogenesis of otit
is media with effusion (OME). A historical perspective of allergy as i
t relates to OME is presented. The study included 89 patients: 48 with
persistent effusion but no recent acute infection, 25 with purulent O
ME complicated by a superimposed infection, and 16 control subjects. A
ll 89 patients had persistent effusion for more than 2 months and subs
equently required the placement of tympanostomy tubes. Allergy was def
ined using the radioallergosorbent test (RAST), serum immunoglobulin E
(IgE) levels, and skin tests. Allergies were present in 97% of the pa
tients with nonacute OME. The relationship between allergy and OME was
corroborated clinically in 89% of patients and was also substantiated
by elevated levels of effusion eosinophil cationic protein (ECP) in 8
7.5% of OME patients. Hstologically, polyclonal antibody staining for
ECP demonstrated the presence of eosinophils in middle ear mucosal bio
psy specimens. This study confirms that OME is a sign of allergic infl
ammation in the middle ear that is associated with an increase in eosi
nophils and a concomitant release of ECP into the effusion in individu
als with allergy demonstrated by skin testing.