Clinical features of asthma complicated with eosinophilic otitis media and the effect of treatment with the anti-IgE monoclonal antibody omalizumub

Abstract

Rationale: Approximately 10% of the patients with asthma are complicated with eosinophilic otitis media (EOM). Although pathogenesis of EOM is supposed to be associated with local production of Th2 cytokines, as with allergic asthma, the relationship between asthma and EOM remains unclear. We therefore investigated the clinical features of asthma patients with EOM and the effect of omalizumub therapy. Method: Of 41 patients with chronic rhinosinusitis were included in this study, 14 patients revealed to have EOM based on full examinations by otolaryngologists, and 27 patients did not have EOM. We compared these two groups in terms of age, sex, atopic factors, smoking history, severity of asthma, pulmonary function and lung image findings including airway wall thickness based on high-resolution CT. In addition, we studied the effect of omalizumab on asthma with EOM. Results: There were no significant differences between two groups in terms of age, sex, atopic factors and the level of serum IgE. Asthma severity, the number of blood eosinophils, Brinkman index and airway wall thickness were each significantly greater in patients with EOM than in those without EOM. Treatment with omalizumab at least for 4 months caused improvements in symptoms of both asthma and EOM. Conclusions: These results suggest that smoking, in concert with eosinophilic airway inflammation, and the resultant airway wall thickness possibly play roles in the pathogenesis of EOM with asthma. Thus, cessation of smoking might be important in preventing development of EOM, and furthermore, early initiation of omalizumab therapy seems to inhibit progression of both diseases.