This study was performed to ascertain the role of
allergy, as defined by skin testing and histochemical markers, in the pathogenesis of
otitis media with effusion (OME). A historical perspective of
allergy as it relates to OME is presented. The study included 89 patients: 48 with persistent effusion but no recent acute
infection, 25 with purulent OME complicated by a superimposed
infection, and 16 control subjects. All 89 patients had persistent effusion for more than 2 months and subsequently required the placement of
tympanostomy tubes.
Allergy was defined using the radioallergosorbent test (RAST), serum
immunoglobulin E (
IgE) levels, and skin tests.
Allergies were present in 97% of the patients with nonacute OME. The relationship between
allergy and OME was corroborated clinically in 89% of patients and was also substantiated by elevated levels of effusion
eosinophil cationic protein (ECP) in 87.5% of OME patients. Histologically, polyclonal antibody staining for ECP demonstrated the presence of eosinophils in middle ear mucosal biopsy specimens. This study confirms that OME is a sign of allergic
inflammation in the middle ear that is associated with an increase in eosinophils and a concomitant release of ECP into the effusion in individuals with
allergy demonstrated by skin testing.