Nagamine Hisayo, Iino Yukiko, Kojima Chie, Miyazawa Tetsuo, Iida Takashi
Department of Otolaryngology, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Auris Nasus Larynx. 2002 Jan;29(1):19-28. doi: 10.1016/s0385-8146(01)00124-9.
Although "eosinophilic otitis media" is not as uncommon a condition as was previously believed, its cause and pathogenesis are not yet fully understood. The purpose of this study was to describe the clinical characteristics in patients with "eosinophilic otitis media" to clarify its pathogenesis.
Seven adult patients with persistent and intractable otitis media with viscous middle ear effusion containing many eosinophils, who were also under treatment for bronchial asthma, were studied. The following examinations were conducted: nasopharyngeal endoscopy, pure-tone audiometry, eustachian tube function test, temporal bone CT scan, blood analysis, bacterial and fungal culture of middle ear effusion, histological study of the middle ear and nasal specimens, and measurement of eosinophilic cationic protein (ECP) in middle ear effusion.
Some patients had persistent perforation with papillomatous granulation tissue arising from the mesotympanic mucosa, and all the patients had nasal polyposis. The pure-tone audiometry showed the mixed-type of hearing loss in all the patients, and the hearing level deteriorated progressively during the course in some patients. The eustachian tube function was not always poor but was patulous in some cases. The most severely diseased areas were in the eustachian tube and mesotympanum by temporal bone CT images. All the seven patients had the high levels of total serum IgE, but the RAST scores were negative in three patients and low grade in three patients. The accumulation of eosinophils was observed in middle ear effusion, middle ear mucosa and nasal polyps, and the eosinophils were highly activated with degranulation. High level of ECP was also recovered from middle ear effusion.
Active eosinophilic inflammation occurs in the entire respiratory tract, including the middle ear in these patients. From our present investigation, we propose the criteria and clinical characteristics of "eosinophilic otitis media".
尽管“嗜酸性粒细胞性中耳炎”并非如之前所认为的那样罕见，但其病因和发病机制尚未完全明确。本研究旨在描述“嗜酸性粒细胞性中耳炎”患者的临床特征，以阐明其发病机制。
对7例患有持续性和难治性中耳炎且中耳积液黏稠并含有大量嗜酸性粒细胞、同时正在接受支气管哮喘治疗的成年患者进行了研究。进行了以下检查：鼻咽内镜检查、纯音听力测定、咽鼓管功能测试、颞骨CT扫描、血液分析、中耳积液的细菌和真菌培养、中耳及鼻标本的组织学研究，以及中耳积液中嗜酸性粒细胞阳离子蛋白（ECP）的测定。
部分患者存在持续性穿孔，伴有从中鼓室黏膜长出的乳头状肉芽组织，所有患者均有鼻息肉。纯音听力测定显示所有患者均为混合性听力损失，部分患者在病程中听力水平逐渐恶化。咽鼓管功能并非总是不良，在某些情况下呈开放状态。颞骨CT图像显示病变最严重的区域位于咽鼓管和中鼓室。所有7例患者血清总IgE水平均较高，但放射变应原吸附试验（RAST）评分3例为阴性，3例为低级别。在中耳积液、中耳黏膜和鼻息肉中均观察到嗜酸性粒细胞的聚集，且嗜酸性粒细胞高度活化并脱颗粒。中耳积液中也检测到高水平的ECP。
在这些患者中，包括中耳在内的整个呼吸道均发生了活跃的嗜酸性粒细胞炎症。根据我们目前的研究，我们提出了“嗜酸性粒细胞性中耳炎”的诊断标准和临床特征。
