Biological Mediators of Inflammation in Middle Ear Effusions

1976 ◽  
Vol 85 (2_suppl) ◽  
pp. 90-96 ◽  
Author(s):  
Joel M. Bernstein
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Potential Role ◽  
Otitis Media With Effusion ◽  
Chemotactic Factor ◽  
Mediators Of Inflammation ◽  
Tube Dysfunction ◽  
Middle Ear Cleft

Four biological mediators of inflammation have been found in middle ear effusions from patients with otitis media with effusion. They are chemotactic factor(s), macrophage inhibition factor(s), activated complement and prostaglandins. The potential role of these mediators has been discussed in relation to their potential for maintaining inflammation in the middle ear cleft after Eustachian tube dysfunction.

Role of Ige-Mediated Hypersensitivity in Otitis Media with Effusion: Pathophysiologic Considerations

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 15-19 ◽  
Author(s):  
Joel M. Bernstein ◽  
William J. Doyle
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Accessory Cell ◽  
Middle Ear Mucosa ◽  
Mucus Production ◽  
Mediators Of Inflammation ◽  
Ige Mediated

A pathophysiologic model of otitis media with effusion secondary to IgE-mediated hypersensitivity is described. Specific mediators of inflammation are released by mucosal mast cells in the nasal mucosa following the interaction of antigen and specific IgE antibody. These mediators increase vascular permeability, mucosal blood flow, and, most important, mucus production. Furthermore, accessory cell types are recruited by colony-stimulating factors that in turn provide an autocrine-positive feedback for the influx of further inflammatory cells. The eustachian tube is then effectively obstructed by both intrinsic venous engorgement and extrinsic mucus plugs, isolating the middle ear space from the ambient environment The net result is the increased exchange of nitrogen into the middle ear mucosa from the middle ear cavity. This causes the development of a significant middle ear underpressure that disrupts tight junctions and allows for transudation of fluids into the middle ear space. The prolonged obstruction of the eustachian tube with mucus results in middle ear inflammation, mucosal metaplasia, and increased glandular activities, all of which are hallmarks of chronic otitis media with effusion.

scholarly journals The Relation of Allergy to Eustachian Tube Dysfunction and the Subsequent Need for Insertion of Pressure Equalization Tubes

2020 ◽  
Vol 99 (1_suppl) ◽  
pp. 39S-47S
Author(s):  
David S. Hurst ◽  
Carter M. Denne
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Basic Question ◽  
Pressure Equalization ◽  
Immune Mediated ◽  
Tube Dysfunction ◽  
Mucosal Edema ◽  
Middle Ear Disease

Introduction: The most basic question to be answered in each case in which the choice of using a pressure equalization tube (PET) is being considered is: “what is the underlying pathophysiology of the middle ear disease being addressed?” Methods: We will evaluate the hypothesis that the Eustachian Tube (ET) may become “dysfunctional” due to allergic mucosal edema and obstruction. We review the literature that evaluates the role of ET, the proposed affect that allergy may contribute to ET dysfunction (ETD), and the relation of allergic rhinitis to otitis. Results: Proof that allergy affects the middle ear was supported by (1) over a dozen investigators using objective immunotherapy demonstrating over the past 70 years that 72% to 100% of the children with otitis media with effusion (OME) are atopic, (2) an association of allergic Th2 immune-mediated histochemical reactivity within the target organ itself, (3) establishment that inflammation within the middle ear is truly allergic in nature, and (4) direct evidence of a dose–response curve and consistency of results, which confirm that OME resolves on allergy immunotherapy. Conclusion: Current medical evidence should heighten the awareness of physicians of the physiology that underlies ETD. The evidence supports the link between allergy and OME. The middle ear behaves like the rest of the respiratory tract, and what has been learned about the atopic response in the sinuses and lungs may be applied to the study of the immunologic mechanisms within the middle ear that lead to ETD requiring the use of PET.

The Role of IgE-Mediated Hypersensitivity in Otitis Media with Effusion: A 1987 Update

1987 ◽  
Vol 1 (2) ◽  
pp. 67-72
Author(s):  
Joel M. Bernstein
Keyword(s):  
Allergic Rhinitis ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Otitis Media With Effusion ◽  
Eustachian Tube Dysfunction ◽  
Upper Respiratory Tract ◽  
Direct Role ◽  
Tube Dysfunction ◽  
Ige Mediated

The role of IgE-mediated hypersensitivity in the development of middle ear disease has not been completely resolved. However, on the basis of our investigations and those of other laboratories, we would suggest that approximately two-thirds of patients with chronic recurrent otitis media (OM) are not allergic. The other third may have allergic rhinitis, and this allergic rhinitis may play a direct role in producing eustachian tube dysfunction in recurrent OM. However, viral infections of the upper respiratory tract may also induce IgE-mediated release of mast cell inflammatory mediators and could cause OM on the basis of viral infection alone. The role of allergic rhinitis on eustachian tube dysfunction is now well documented, and finally, the possible role of food allergy and OM must be seriously considered, particularly in the young OM-prone child with chronic recurrent rhinitis and OM.

Relationship between Eustachian tube dysfunction and otitis media with effusion in radiotherapy patients

2018 ◽  
Vol 132 (2) ◽  
pp. 111-116 ◽  
Author(s):  
K Akazawa ◽  
H Doi ◽  
S Ohta ◽  
T Terada ◽  
M Fujiwara ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Otitis Media With Effusion ◽  
Intensity Modulated Radiotherapy ◽  
Eustachian Tube Dysfunction ◽  
Dose Volume ◽  
Tube Dysfunction ◽  
The Relationship ◽  
Higher Doses

AbstractObjective:This study evaluated the relationship between radiation and Eustachian tube dysfunction, and examined the radiation dose required to induce otitis media with effusion.Methods:The function of 36 Eustachian tubes in 18 patients with head and neck cancer were examined sonotubometrically before, during, and 1, 2 and 3 months after, intensity-modulated radiotherapy. Patients with an increase of 5 dB or less in sound pressure level (dB) during swallowing were categorised as being in the dysfunction group. Additionally, radiation dose distributions were assessed in all Eustachian tubes using three dose–volume histogram parameters.Results:Twenty-two of 25 normally functioning Eustachian tubes before radiotherapy (88.0 per cent) shifted to the dysfunction group after therapy. All ears that developed otitis media with effusion belonged to the dysfunction group. The radiation dose threshold evaluation revealed that ears with otitis media with effusion received significantly higher doses to the Eustachian tubes.Conclusion:The results indicate a relationship between radiation dose and Eustachian tube dysfunction and otitis media with effusion.

The Role of Eustachian Tube Dysfunction in Immune-Mediated Middle Ear Effusion and Inflammation

1985 ◽  
Vol 12 ◽  
pp. S203-S205 ◽  
Author(s):  
Allen F. Ryan ◽  
Jeffrey P. Harris ◽  
Antonino Catanzaro ◽  
Stephen I. Wasserman
Keyword(s):  
Eustachian Tube ◽  
Middle Ear ◽  
Eustachian Tube Dysfunction ◽  
Middle Ear Effusion ◽  
Immune Mediated ◽  
Tube Dysfunction ◽  
Ear Effusion

Pseudomonas Otitis Media after Eustachian Tube Obstruction

1992 ◽  
Vol 107 (4) ◽  
pp. 511-515 ◽  
Author(s):  
Patrick J. Antonelli ◽  
Steven K. Juhn ◽  
Marcos V. Goycoolea ◽  
G. Scott Giebink
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Suppurative Otitis Media ◽  
Tube Obstruction ◽  
Colony Forming Units ◽  
Tube Function ◽  
Pseudomonas Infection

Previous experiments have shown that Pseudomonas aeruginosa may infect the middle ears of chinchillas by way of the eustachian tube and that chinchillas with acute otitis media (AOM) are more susceptible to pseudomonas infection than animals without AOM. The purpose of this experiment was to examine the effects of otitis media with effusion (OME), induced by means of eustachian tube obstruction, on middle ear susceptibility to nasal inoculation of P. aeruginosa. Chinchilla eustachian tubes were obstructed with silicone rubber sponge bilaterally; OME developed in eight animals (11 ears)—three bilaterally and five unilaterally—and persisted for 6 months. Ten chinchillas with normal eustachian tube function served as controls. All animals were nasally inoculated with 5 times 104 colony-forming units of P. aeruginosa. Pseudomonas otitis media developed in eight of 11 OME ears with effusion, none of five ears without OME, and four of 20 control ears (X2 = 11.782, p = 0.003). Therefore, P. aeruginosa can infect the middle ear by way of the eustachian tube. Tubal dysfunction may lead to the development of chronic suppurative otitis media by increasing tubotympanic susceptibility to opportunistic pathogens.

Nasal and Otologic Effects of Experimental Influenza a Virus Infection

1994 ◽  
Vol 103 (1) ◽  
pp. 59-69 ◽  
Author(s):  
William J. Doyle ◽  
Craig A. Buchman ◽  
David P. Skoner ◽  
James T. Seroky ◽  
Frederick Hayden ◽  
...  
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Influenza A ◽  
Serum Antibody ◽  
Eustachian Tube Dysfunction ◽  
Upper Respiratory Tract ◽  
Tube Dysfunction ◽  
Antibody Titers ◽  
Experimental Influenza

Past studies showed that experimental rhinovirus colds in adults resulted in eustachian tube dysfunction and abnormal middle ear pressures. In the present study, the symptoms and pathophysiologic findings accompanying experimental influenza viral infection were documented. A total of 33 healthy adult volunteers were intranasally challenged with an influenza A/Kawasaki/86 (H1N1) virus and cloistered over a 9-day postchallenge period to monitor for evidence of infection, signs and symptoms of illness, and the extent and frequency of pathophysiologic responses of the nose, eustachian tube, and middle ear. Results showed a protective effect of high (≥16) prechallenge specific hemagglutination-inhibition antibody titer on the rate of infection and the magnitude and extent of provoked symptoms and pathophysiologic findings. Infected subjects with low (<16) prechallenge serum antibody titers (n = 21) developed significant respiratory illness. These subjects also had objectively measurable increases in nasal secretion production, and decreased nasal patency and mucociliary clearance rates. More than 80% of the infected subjects developed eustachian tube dysfunction, and approximately 80% had middle ear underpressures of less than −100 mm H2O on study days 4 and 5. Five of 21 infected subjects with low prechallenge antibody titers had otoscopic evidence of otitis media with effusion. These results support a causal role for viral upper respiratory tract infection in the pathogenesis of otitis media, possibly mediated by the early development of eustachian tube dysfunction and abnormal middle ear pressure.

Otitis Media with Effusion

1978 ◽  
Vol 87 (2) ◽  
pp. 191-196 ◽  
Author(s):  
M. Persico ◽  
L. Podoshin ◽  
M. Fradis
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Otitis Media With Effusion ◽  
Surface Active Agent ◽  
Combined Treatment ◽  
Active Agent ◽  
Systemic Steroid ◽  
Tube Dysfunction ◽  
Chemotherapeutic Treatment ◽  
The One

Eustachian tube dysfunction has been considered the main factor in the etiology of otitis media with effusion (OME). A short-term systemic steroid therapy, with combined chemotherapeutics, yielded 53.1% cure in 160 children in which OME had been diagnosed, whereas only 12.5% of similar 116 children were cured by chemotherapeutic treatment alone. It is postulated that steroids, acting by a mechanism much similar to the one in the newborn lung, increase the level of a tubal surface active agent, thus enhancing Eustachian tube refunctioning. This combined treatment, we believe, deserves its place as a routine conservative trial before surgery.

Refractory otitis media with effusion from viewpoints of eustachian tube dysfunction and nasal sinusitis

1993 ◽  
Vol 14 (3) ◽  
pp. 187-190 ◽  
Author(s):  
Akihiko Fujita ◽  
Iwao Honjo ◽  
Kyosuke Kurata ◽  
I-Ken Gan ◽  
Haruo Takahashi
Keyword(s):  
Otitis Media ◽  
Eustachian Tube ◽  
Otitis Media With Effusion ◽  
Eustachian Tube Dysfunction ◽  
Tube Dysfunction
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