679 SEROUS OTITIS MEDA: EVIDENCE FOR AN ALLERGIC MECHANISM

Abstract

The importance of allergy in the pathogenesis of serous otitis media continues to be controversial. Our aim is to clarify the role of atopy in the development of serous otitis and to describe a technique for the further study of this relationship.Nasal challenges were performed with both diluent and rye grass pollen extract in 43 children with allergic rhinitis. Nasal airway resistance was measured by anterior rhinomanometry and nearly simultaneous tympanometry was utilized to detect changes in middle ear pressure. Fifteen of the patients had significant changes in middle ear pressure of minus 35 mm H2O or greater in one or both ears (mean=minus 60 mm). The control diluent challenges in the same group resulted in a mean change of plus 20 mm H2O (p<0.001).Significant obstructive increase (≥50%) in nasal airway resistance was observed in 32 of 43 patients (74%). Negative shift in middle ear pressure was seen in 28 of these 32 patients (88%) as compared to only 2 of 11 patients (18%) with a nasal airway resistance increase of less than 50%. All 15 patients with significant middle ear pressure changes had a nasal airway resistance increase of ≥50%.These results indicate that allergic rhinitis patients who react to nasal antigen challenge demonstrated concomitant significant changes in middle ear pressure. Persistent negative pressure in the middle ear can produce an effusion characteristic of serous otitis media. We interpret this data to indicate that allergic children have increased susceptibility to serous otitis media.