Eosinophilic otitis media: an intractable middle ear disease

Introduction:

Eosinophilic otits media (EOM) is an intractable form of otitis media characterized by a highly viscous yellow effusion containing eosinophils and IgE. Especially patients with asthma and chronic rhinosinusitis are affected and it is resistant to conventional treatment of otitis media. Women in their 50 s are the most affected. The standard therapy of the EOM is the installation of triamcinolone into the middle ear.

Methods:

A 53-year-old Japanese patient with a 10 year history of asthma and st. p. sinus surgery in chronic rhinosinusitis with nasal polyps has been complaining about recurrent otitis and hearing loss since 2009. In the ear microscopy, a perforation of the tympanic membrane with yellowish effusion was shown on the right side and an intact tympanic membrane with effusion on the other ear.

Results:

From the middle ears a yellowish, highly viscous effusion could be extracted on repeated visits to our polyclinic. Pure tone audiograms showed a conductive hearing loss with sensorial hearing loss in high frequencies. The cytological study revealed an extensive eosinophilia. A temporal bone CT scan shows opacification of both mastoids. After presentation of the patient in the department of rheumatology and discussion in a vasculitis conference triamcinolone is installed into the middle ear in a 4-week interval.

Conclusion:

In patients with treatment-resistant otitis media with asthma, an EOM should be considered in the differential diagnosis to start an appropriate treatment. Patients should be advised that this is a long-term disease and that a progressive hearing loss can occur. Due to the risk of hearing impairment the indication for surgical treatment should be cautious.

Publication History

Publication Date:
18 April 2018 (online)