Skip to main content
SpringerLink
Log in

Eosinophilic Otitis Media: Modern Aspects of Pathogenesis, Clinical Features, Diagnosis and Treatment

  • Other Articles
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Eosinophilic otitis media (EOM) is an inflammatory chronic disease of the middle ear, characterized by the presence of a particularly viscous effusion with a high content of protein toxins of eosinophilic origin in the middle ear cavity. The pathology has relationship with bronchial asthma, allergic rhinitis and chronic rhinosinusitis with nasal polyps. EOM is characterized by a sluggish course, a tendency to relapse, which can lead to a gradual hearing decrease up to complete deafness. In this paper, we reviewed the international literature with special attention to pathogenesis and treatment management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Koch H (1947) Allergical investigations of chronic otitis. Acta Otolaryngol 62(Suppl.):1–201

    Google Scholar 

  2. Tomioka S, Yuasa R, lino Y (1994) Intractable otitis media in cases with bronchial asthma. Recent advances in otitis media with effusion. In: Proceedings of the second extraordinary international symposium on recent advances on otitis media. Kugler Publications, Inc., Amsterdam, pp 183–186

  3. Suzuki H, Matsutani S, Kawase T, Iino Y, Kawauchi H, Gyo K et al (2004) Epidemiologic surveillance of ‘‘eosinophilic otitis media’’ in Japan. Otol Jpn 14:112–117 (In Japanese)

    Google Scholar 

  4. Grossman J (1997) One airway, one disease. Chest 111(2 Suppl):11S–16S. https://doi.org/10.1378/chest.111.2_supplement.11s

    Article  CAS  PubMed  Google Scholar 

  5. Azadarmaki R, Westra W, Prasad S (2015) Eosinophilic Mucin otomastoiditis and otopolyposis: a progressive form of eosinophilic otitis media. Ann Otol Rhinol Laryngol 124(9):752–756. https://doi.org/10.1177/0003489415577988

    Article  PubMed  Google Scholar 

  6. Neff BA, Voss SG, Carlson ML, O’Brien EK, Butterfield JH (2017) Treatment of eosinophilic otitis media with pegylated interferonalpha 2a and 2b. Laryngoscope 127:1208–1216

    Article  CAS  Google Scholar 

  7. Lara-Sánchez H, Vallejo L (2017) Eosinophilic otitis media. N Engl J Med 376(7):e10. https://doi.org/10.1056/NEJMicm1510852

    Article  PubMed  Google Scholar 

  8. Chow K, Cosetti M (2020) Use of IL-5 inhibitor benralizumab as a novel therapy for eosinophilic otitis media. Otol Neurotol 41(2):e238–e240. https://doi.org/10.1097/MAO.0000000000002493

    Article  PubMed  Google Scholar 

  9. Iino Y, Tomioka-Matsutani S, Matsubara A, Nakagawa T, Nonaka M (2011) Diagnostic criteria of eosinophilic otitis media, a newly recognized middle ear disease. Auris Nasus Larynx 38:456–461

    Article  Google Scholar 

  10. Omori M, Ziegler S (2007) Induction of IL-4 expression in CD4(+) T cells by thymic stromal lymphopoietin. J Immunol 178(3):1396–1404. https://doi.org/10.4049/jimmunol.178.3.1396

    Article  CAS  PubMed  Google Scholar 

  11. Simson L, Foster PS (2000) Chemokine and cytokine cooperativity: eosinophil migration in the asthmatic response. Immunol Cell Biol 78(4):415–422. https://doi.org/10.1046/j.1440-1711.2000.00922.x

    Article  CAS  PubMed  Google Scholar 

  12. Yao T, Kojima Y, Koyanagi A et al (2009) Eotaxin-1, -2, and -3 immunoreactivity and protein concentration in the nasal polyps of eosinophilic chronic rhinosinusitis patients. Laryngoscope 119(6):1053–1059. https://doi.org/10.1002/lary.20191

    Article  CAS  PubMed  Google Scholar 

  13. Ueki S, Konno Y, Takeda M, Moritoki Y, Hirokawa M, Matsuwaki Y, Honda K, Ohta N, Yamamoto S, Takagi Y, Wada A, Weller PF (2016) Eosinophil extracellular trap cell death-derived DNA traps: their presence in secretions and functional attributes. J Allergy Clin Immunol 137(1):258–267. https://doi.org/10.1016/j.jaci.2015.04.041Epub 2015 Jun 9

    Article  CAS  PubMed  Google Scholar 

  14. IinoY Kakizaki K, Saruya S, Katano H, Komiya T, Kodera K et al (2006) Eustachian tube function in patients with eosinophilic otitis media associated with bronchial asthma evaluated by sonotubometry. Arch Otolaryngol Head Neck Surg 132:1109–1114

    Article  Google Scholar 

  15. Kanazawa H, Yoshida N, Hara M, Hasegawa M, Matsuzawa S, Shinnabe A et al (2013) Risk factors for eosinophilic otitis media in patients with eosinophilic chronic rhinosinusitis. Int Adv Otol 9:353–358

    Google Scholar 

  16. Iino Y (2010) Role of IgE in eosinophilic otitis media. Allergol Int 59:233–238. https://doi.org/10.2332/allergolint.10-RAI-0223

    Article  CAS  PubMed  Google Scholar 

  17. Ohta N, Ueki S, Konno Y, Hirokawa M, Kubota T, Tomioka-Matsutani S, Suzuki T, Ishida Y, Kawano T, Miyasaka T, Takahashi T, Suzuki T, Ohno I, Kakehata S, Fujieda S (2018) ETosis-derived DNA trap production in middle ear effusion is a common feature of eosinophilic otitis media. Allergol Int 67(3):414–416. https://doi.org/10.1016/j.alit.2017.11.007

    Article  PubMed  Google Scholar 

  18. Ueki S, Ohta N, Takeda M, Konno Y, Hirokawa M (2017) Eosinophilic otitis media: the aftermath of eosinophil extracellular trap cell death. Curr Allergy Asthma Rep 17(5):33. https://doi.org/10.1007/s11882-017-0702-5

    Article  CAS  PubMed  Google Scholar 

  19. Papayannopoulos V, Metzler KD, Hakkim A, Zychlinsky A (2010) Neutrophil elastase and myeloperoxidase regulate the formation of neutrophil extracellular traps. J Cell Biol 191(3):677–691. https://doi.org/10.1083/jcb.201006052

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Uchimizu H, Matsuwaki Y, Kato M, Otori N, Kojima H (2015) Eosinophil-derived neurotoxin, elastase, and cytokine profile in effusion from eosinophilic otitis media. Allergol Int 64(Suppl):S18–S23. https://doi.org/10.1016/j.alit.2015.03.007Epub 2015 Apr 25

    Article  PubMed  Google Scholar 

  21. Miura T, Matsubara A, Kudo N, Hara R, Takahata J, Sasaki A (2018) The expression of thymic stromal lymphopoietin in patients and animal models with eosinophilic otitis media. Acta Otolaryngol 138(5):447–451. https://doi.org/10.1080/00016489.2017.1416170

    Article  CAS  PubMed  Google Scholar 

  22. Nonaka M, Fukumoto A, Ozu C, Mokuno E, Baba S, Pawankar R et al (2003) IL-5 and eotaxin levels in middle ear effusion and blood from asthmatics with otitis media with effusion. Acta Otolaryngol 123:383–387

    Article  CAS  Google Scholar 

  23. Iino Y, Kakizaki K, Katano H, Saigusa H, Kanegasaki S (2005) Eosinophil chemoattractant in middle ear patients with eosinophilic otitis media. Clin Exp Allergy 35:1370–1376

    Article  CAS  Google Scholar 

  24. Iino Y, Nagamine H, Yabe T, Matsutani S (2001) Eosinophils are activated in middle ear mucosa and middle ear effusion of patients with intractable otitis media associated with bronchial asthma. Clin Exp Allergy 31:1135–1143

    Article  CAS  Google Scholar 

  25. Matsubara A, Nishizawa H, Kurose A, Nakagawa T, Takahata J, Sasaki A (2014) An experimental study of inner ear injury in an animal model of eosinophilic otitis media. Acta Otolaryngol 134(3):227–232. https://doi.org/10.3109/00016489.2013.859395(Epub 2013 Dec 23)

    Article  PubMed  Google Scholar 

  26. Kudo N, Matsubara A, Nishizawa H, Miura T (2017) Immunohistological analysis of eotaxin and RANTES in the model animal of eosinophilic otitis media. Acta Otolaryngol 137(5):476–481. https://doi.org/10.1080/00016489.2016.1266508(Epub 2016 Dec 16)

    Article  CAS  PubMed  Google Scholar 

  27. Takayama G, Arima K, Kanaji T, Toda S, Tanaka H, Shoji S et al (2006) Periostin: a novel component of subepithelial fibrosis of bronchial asthma downstream of IL-4 and IL-13-signals. J Allergy Clin Immunol 118:98–104

    Article  CAS  Google Scholar 

  28. Okamoto M, Hoshino T, Kitasato Y, Sakazaki Y, Kawayama T, Fujimoto K et al (2011) Periostin, a matrix protein, is a novel biomarker for idiopathic interstitial pneumonias. Eur Respir J 5:1119–1127

    Article  Google Scholar 

  29. Nishizawa H, Matsubara A, Nakagawa T, Ohta N, Izuhara K, Shirasaki T, Abe T, Takeda I, Shinkawa H (2012) The role of periostin in eosinophilic otitis media. Acta Otolaryngol 132(8):838–844. https://doi.org/10.3109/00016489.2012.668708Epub 2012 Jun 5

    Article  CAS  PubMed  Google Scholar 

  30. Iino Y (2008) Eosinophilic otitis media: a new middle ear disease entity. Curr Allergy Asthma Rep 8(6):525–530

    Article  Google Scholar 

  31. Kanazawa H, Yoshida N, Yamamoto H, Hara M, Hasegawa M, Matsuzawa S, Shinnabe A, Iino Y (2014) Risk factors associated with severity of eosinophilic otitis media. Auris Nasus Larynx 41(6):513–517. https://doi.org/10.1016/j.anl.2014.08.003

    Article  PubMed  Google Scholar 

  32. Tanaka Yukako, Nonaka Manabu, Yamamura Yukie, Tagaya Etsuko, Pawankar Ruby, Yoshihara Toshio (2013) Improvement of eosinophilic otitis media by optimized asthma treatment. Allergy Asthma Immunol Res 5(3):175–178

    Article  CAS  Google Scholar 

  33. Seo Yukako, Nonaka Manabu, Yamamura Yukie (2018) Optimal control of asthma improved eosinophilic otitis media. Asia Pacific Allergy 8(1):e5

    Article  Google Scholar 

  34. Chung WJ, Lee JH, Lim HK, Yoon TH, Cho KJ, Baek JH (2012) Eosinophilic otitis media: CT and MRI findings and literature review. Korean J Radiol 13(3):363–367. https://doi.org/10.3348/kjr.2012.13.3.363

    Article  PubMed  PubMed Central  Google Scholar 

  35. Saliba I, Alzahrani M, Weng X, Bestavros A (2017) Eosinophilic otitis media diagnosis using flow cytometric immunophenotyping. Acta Oto-Laryngol. https://doi.org/10.1080/00016489.2017.1385845

    Article  Google Scholar 

  36. Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 33:1094–1100

    Article  CAS  Google Scholar 

  37. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37:187–192

    Article  CAS  Google Scholar 

  38. Harabuchi Yasuaki, Kishibe Kan, Tateyama Kaori, Morita Yuka, Yoshida Naohiro, Kunimoto Yasuomi, Matsui Takamichi, Sakaguchi Hiroshi, Okada Masahiro, Watanabe Takeshi, Inagaki Akira, Kobayashi Shigeto, Iino Yukiko, Murakami Shingo, Takahashi Haruo, Tono Tetsuya (2017) Clinical features and treatment outcomes of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV): a retrospective analysis of 235 patients from a nationwide survey in Japan. Mod Rheumatol 27(1):87–94. https://doi.org/10.1080/14397595.2016.1177926

    Article  CAS  PubMed  Google Scholar 

  39. Ishiyama A, Canalis RF (2001) Otological manifestations of Churg–Strauss syndrome. Laryngoscope 111(9):1619–1624. https://doi.org/10.1097/00005537-200109000-00024

    Article  CAS  PubMed  Google Scholar 

  40. Martinez Del Pero M, Moffat D, Sudhoff H (2008) Unusual presentation of temporal bone involvement in Churg–Strauss syndrome. J Laryngol Otol 122:425–427

    Article  CAS  Google Scholar 

  41. Seccia V, Fortunato S, Cristofani-Mencacci L et al (2016) Focus on audiologic impairment in eosinophilic granulomatosis with polyangiitis. Laryngoscope 126(12):2792–2797. https://doi.org/10.1002/lary.25964

    Article  CAS  PubMed  Google Scholar 

  42. Ovadia S, Dror I, Zubkov T, Tanay A, Levy D, Zandman-Goddard G (2009) Churg–Strauss syndrome: a rare presentation with otological and pericardial manifestations: case report and review of the literature. Clin Rheumatol 28(Suppl. 1):S35–S38

    Article  Google Scholar 

  43. Groh M, Pagnoux C, Baldini C et al (2015) Eosinophilic granulomatosis with polyangiitis (Churg–Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. Eur J Intern Med 26:545–553

    Article  Google Scholar 

  44. Fukuda A, Morita S, Nakamaru Y, Hoshino K, Fujiwara K, Homma A (2019) Differentiation between eosinophilic otitis media and otitis media associated with eosinophilic granulomatosis with polyangiitis. Otol Neurotol 40(8):e796–e802. https://doi.org/10.1097/MAO.0000000000002295

    Article  PubMed  Google Scholar 

  45. Chusid MJ, Dale DC, West BC, Wolff SM (1975) The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine 54(1):1–27. https://doi.org/10.1097/00005792-197501000-00001

    Article  CAS  PubMed  Google Scholar 

  46. Takayama K, Yadohisa O, Furuno T, Hashimoto S, Nakanishi Y, Abe M et al (1995) Case report: the first report of idiopathic hypereosinophilic syndrome involved with lung and middle ear. Am J Med Sci 309:282–284

    CAS  PubMed  Google Scholar 

  47. Reiter A, Gotlib J (2017) Myeloid neoplasms with eosinophilia. Blood 129(6):704–714. https://doi.org/10.1182/blood-2016-10-695973

    Article  CAS  PubMed  Google Scholar 

  48. Longmore M, Wilkinson I, Turmezei T, Cheung CK (2007). Oxford handbook of clinical medicine. Oxford. p 316. ISBN:978-0-19-856837-7

  49. Iino Y, Nagamine H, Kakizaki K, Komiya T, Katano H, Saruya S et al (2006) Effectiveness of instillation of triamcinolone acetonide into the middle ear for eosinophilic otitis mediaassociated with bronchial asthma. Ann Allergy Asthma Immunol 97:761–766

    Article  CAS  Google Scholar 

  50. Iino Y, Nagamine H, Kakizaki K et al (2006) Effectiveness of instillation of triamcinolone acetonide into the middle ear for eosinophilic otitis media associated with bronchial asthma. Ann Allergy Asthma Immunol 97(6):761–766. https://doi.org/10.1016/S1081-1206(10)60967-2

    Article  CAS  PubMed  Google Scholar 

  51. Matsubara A, Kuroda R, Usami S, Takahata J, Shinkawa H (2001) The effect of topical administration of heparin to the eosinophilic otitis media. In: Takasaka T, Yuasa R, Hozawa K (eds) Recent advances in otitis media. Bologna: Monduzzi Editore, pp 403–406

  52. Esu Y, Iino Y, Masuda M, Kanazawa H, Yoshida N (2018) Proposal of a treatment strategy for eosinophilic otitis media based on middle ear condition. Otol Neurotol 39(8):e671–e678. https://doi.org/10.1097/MAO.0000000000001912

    Article  PubMed  Google Scholar 

  53. Okude A, Tagaya E, Kondo M, Nonaka M, Tamaoki J (2012) A case of severe asthma with eosinophilic otitis media successfully treated with anti-IgE monoclonal antibody omalizumab. Case Rep Pulmonol 2012:340525

    PubMed  PubMed Central  Google Scholar 

  54. Smith KA, Pulsipher A, Gabrielsen DA, Alt JA (2018) Biologics in chronic rhinosinusitis: an update and thoughts for future directions. Am J Rhinol Allergy 32:412–423

    Article  Google Scholar 

  55. FDA approves first treatment for chronic rhinosinusitis with nasal polyps [news release]. Silver Spring, MD: Food and Drug Administration Office of Media Affairs; 2019. Avaliable at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatmentchronic-rhinosinusitis-nasal-polyps. Accessed July 2 2019

  56. Iino Y, Takahashi E, Ida S, Kikuchi S (2019) Clinical efficacy of anti-IL-5 monoclonal antibody mepolizumab in the treatment of eosinophilic otitis media. Auris Nasus Larynx 46(196–203):15

    Google Scholar 

  57. Iino Y, Hara M, Hasegawa M et al (2012) Clinical efficacy of anti-IgE therapy for eosinophilic otitis media. Otol Neurotol 33:1218–1224

    Article  Google Scholar 

  58. Iino Y, Hara M, Hasegawa M et al (2014) Effect of omalizumab on biomarkers in middle ear effusion in patients with eosinophilic otitis media. Acta Otolaryngol 134(4):366–372. https://doi.org/10.3109/00016489.2013.868601

    Article  CAS  PubMed  Google Scholar 

  59. El-Qutob D (2016) Off-label uses of omalizumab. Clinic Rev Allerg Immunol 50:84–96. https://doi.org/10.1007/s12016-015-8490-y

    Article  CAS  Google Scholar 

  60. Markham A (2018) Benralizumab: first global approval. Drugs 78:505–511. https://doi.org/10.1007/s40265-018-0876-8

    Article  CAS  PubMed  Google Scholar 

  61. Wada T, Uemaetomari I, Murashita H et al (2006) Successful treatment of eosinophilic otitis media using ramatroban: report of two cases. Auris Nasus Larynx 33(4):455–460. https://doi.org/10.1016/j.anl.2006.05.007

    Article  PubMed  Google Scholar 

  62. Iino Y, Usubuchi H, Kodama K et al (2010) Eosinophilic inflammation in the middle ear induces deterioration of bone-conduction hearing level in patients with eosinophilic otitis media. Otol Neurotol 31:100–104

    Article  Google Scholar 

  63. Iwasaki S, Nagura M, Mizuta K (2006) Cochlear implantation in a patient with eosinophilic otitis media. Eur Arch Otorhinolaryngol 263:365–369. https://doi.org/10.1007/s00405-005-1006-2

    Article  PubMed  Google Scholar 

  64. Sugimoto H, Hatano M, Noda M et al (2017) Cochlear implantation in deaf patients with eosinophilic otitis media using subtotal petrosectomy and mastoid obliteration. Eur Arch Otorhinolaryngol 274:1173–1177. https://doi.org/10.1007/s00405-016-4091-5

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Ear, Nose and Throat Diseases, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Russian Federation Ministry of Health, Moscow, Russia

    Elena Shevchik, Valery Svistushkin, Galina Nikiforova & Anna Zolotova

Authors
  1. Elena Shevchik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valery Svistushkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Galina Nikiforova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Zolotova
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elena Shevchik.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

This article contains review of literary data. We havn’t made any research including human participants or animals.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shevchik, E., Svistushkin, V., Nikiforova, G. et al. Eosinophilic Otitis Media: Modern Aspects of Pathogenesis, Clinical Features, Diagnosis and Treatment. Indian J Otolaryngol Head Neck Surg 74 (Suppl 1), 132–140 (2022). https://doi.org/10.1007/s12070-020-01903-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-020-01903-z

Keywords

Search

Navigation