The First US Cohort of Eosinophilic Otitis Media: Clinical Characteristics

Abstract

Eosinophilic otitis media(EOM)is an under-recognized cause of refractory otitis media(OM). Misdiagnosis of EOM may result in treatment failure because it does not resolve with usual treatments(oral antibiotics, tympanostomy tubes,topical steroids)and may result in hearing loss. In a Japanese study(2011),EOM was strongly associated with bronchial asthma and chronic rhinosinusitis. Here, we report the first US cohort of EOM. We performed a retrospective study of 32 patients with EOM. Diagnosis was based on a history of chronic refractory OM, viscous middle ear effusion(MEE)or aural polyps, and presence of comorbidities including asthma and nasal polyps. Nineteen of the 32 patients(59%)had MEE fluid analyzed for eosinophilic cationic protein(ECP)by ELISA. The average age of EOM onset was 55.5 years. All patients(32/32)had a history of asthma and nasal polyposis, and 13/32(40%)had a convincing history of aspirin sensitivity. MEE ECP levels ranged from 218-34,506ng/ml, and 13/19(68%) had elevated ECP levels(defined as>1,000ng/ml). Thirty patients had a documented CBC, and 12/30(40%)had an eosinophil level of >/=1.00x109cells/L(reference range 0.05-0.5x109cells/L). In our cohort of 32 EOM patients, we found high rates of aspirin sensitivity and peripheral eosinophilia. Aspirin sensitivity in EOM has been recognized previously, but peripheral eosinophilia is not well described. To our knowledge, this is the first reported US cohort of EOM patients. The incidence of EOM in the US remains unknown, in part because this disease is under-recognized. Failure to recognize EOM may result in progressive or sudden hearing loss. Therefore, it is important for allergists to recognize EOM so appropriate treatment can be initiated.