Jichi Medical University Saitama Medical Center, Department of Otolaryngology, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan.
Jichi Medical University Saitama Medical Center, Department of Otolaryngology, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan.
Auris Nasus Larynx. 2021 Apr;48(2):207-213. doi: 10.1016/j.anl.2020.08.001. Epub 2020 Sep 1.
Eosinophilic otitis media (EOM) is an intractable type of otitis media in which sensorineural hearing loss (SNHL) progresses over time. Clinically, bacterial infection complicates the course of EOM, making it challenging to control otorrhea/middle ear effusion (MEE) from infected ears, and accelerates the progression of SNHL. In this study, we focused on infection, one of the risk factors for SNHL in EOM, and analyzed factors associated with it.
In this cohort study, we evaluated 144 ears of 72 patients diagnosed with bilateral EOM. Patients visited our hospital once every 1-3 months and received intratympanic or systematic administration of steroids when otorrhea/MEE was observed. Several investigations, including blood tests, otorrhea/MEE cytology, bacterial culture tests, and respiratory function tests, were performed. In the otorrhea/MEE cytology, the leukocyte fraction was measured.
Two risk factors for SNHL in EOM were middle ear mucosal thickening (p <0.01) and infection (p <0.05). Compared to the group with <40% neutrophils in otorrhea/MEE samples, groups with 40-70% and ≥70% neutrophils had a significantly higher bone conduction hearing level (p <0.01, p <0.05, respectively). Two risk factors associated with the occurrence of infection in EOM were tympanic membrane (TM) perforation (p <0.01) and the coincidence of otorrhea/MEE and rhinorrhea in bacterial culture test results (p <0.001). A positive correlation was observed between TM perforation and infection (p <0.001). Our analysis of the relationship between the frequency of intratympanic corticosteroids administration and the time-period until the occurrence of TM perforation showed that >4 intratympanic administrations/year significantly increased the risk of perforation (p<0.001). Pseudomonas aeruginosa was isolated from otorrhea/MEE samples, while Pseudomonas aeruginosa and fungi, detected in cultures of rhinorrhea samples, were significantly related to the deterioration of bone conduction hearing levels.
The risk factors associated with the occurrence of infection in patients with EOM were TM perforation and the coincidence of otorrhea/MEE and rhinorrhea in bacterial culture test results. Since TM perforation is likely to occur even due to intratympanic corticosteroids administration, it is necessary to confirm whether the frequency of treatment is appropriate and try a less invasive technique of administration. Furthermore, Pseudomonas aeruginosa infection poses a high risk for the development of SNHL, and clinicians should be alert to this possibility, even if the bacteria were identified only in cultures of rhinorrhea samples.
嗜酸细胞性中耳炎（EOM）是一种难以治愈的中耳炎，其感音神经性听力损失（SNHL）会随着时间的推移而逐渐加重。临床上，细菌感染会使 EOM 的病程复杂化，使受感染的耳朵难以控制耳漏/中耳积液（MEE），并加速 SNHL 的进展。在本研究中，我们关注感染这一 EOM 导致 SNHL 的风险因素之一，并分析与之相关的因素。
在这项队列研究中，我们评估了 72 例双侧 EOM 患者的 144 只耳朵。患者每 1-3 个月到我院就诊一次，当观察到耳漏/MEE 时，给予鼓室内或全身类固醇治疗。进行了包括血液检查、耳漏/MEE 细胞学、细菌培养试验和呼吸功能检查在内的多项检查。在耳漏/MEE 细胞学中，测量白细胞分数。
EOM 中 SNHL 的两个危险因素是中耳黏膜增厚（p<0.01）和感染（p<0.05）。与耳漏/MEE 样本中中性粒细胞<40%的组相比，中性粒细胞 40-70%和≥70%的组骨导听力水平显著更高（p<0.01，p<0.05，分别）。与 EOM 感染相关的两个危险因素是鼓膜穿孔（p<0.01）和细菌培养试验结果中耳漏/MEE 和鼻漏同时存在（p<0.001）。鼓膜穿孔与感染呈正相关（p<0.001）。我们对鼓室内皮质类固醇给药频率与发生鼓膜穿孔时间之间的关系进行分析，结果表明每年>4 次鼓室内给药显著增加穿孔风险（p<0.001）。从耳漏/MEE 样本中分离出铜绿假单胞菌，而从鼻漏样本培养物中检测到的铜绿假单胞菌和真菌与骨导听力水平恶化显著相关。
与 EOM 患者感染发生相关的危险因素是鼓膜穿孔和细菌培养试验中耳漏/MEE 和鼻漏同时存在。由于即使通过鼓室内皮质类固醇给药也可能发生鼓膜穿孔，因此有必要确认治疗频率是否合适，并尝试使用侵入性更小的给药技术。此外，铜绿假单胞菌感染会增加 SNHL 发展的风险，临床医生应警惕这种可能性，即使细菌仅在鼻漏样本的培养物中被发现。
