Chronic Otitis Media (secretory) and Nasal Allergy

The possible causal role of the nasal mucosa and nasal allergy in chronic otitis media with or without effusion was studied in 38 young adults by means of nasal provocation tests (NPT) with various inhalant allergens, performed by rhinomanometry and combined with tympanometry. The parameters were recorded before and up to 56 hrs after the allergen challenge. Of the 38 patients in whom 109 NPTs were performed, 31 patients developed 76 positive nasal responses (NR): 21 isolated immediate NR (IINR), 24 isolated late NR (ILNR), 15 dual late NR (DLNR = immediate + late NR), 11 isolated delayed NR (IDYNR), 5 dual delayed NR (DDYNR = immediate + delayed NR) and 21 negative responses (NNR). Seven patients did not develop any nasal response during 12 NPTs. The 61 positive NRs (80 %) and 5 negative NRs were accompanied by significant changes in the middle ear pressure (MEP), which means that the slightly negative MEP increased in negativity, by otalgia, middle ear tension, and decrease in hearing. In 6 patients the middle ear secretions increased through the monolateral ventilation tubes, during 13 positive NRs. These results suggest the possible causal role of the nasal mucosa and nasal allergy in some patients with chronic otitis media. The hypersensitivity reactions in the nasal mucosa may cause either a primary NR of various types, inducing then secondarily the middle ear response, or this reaction can lead primarily to the middle ear response without appearance of a clinical NR. Both mechanisms may have therapeutic consequences for chronic otitis media. These results stress the importance of nasal challenges with allergens, combined with tympanometry, for the diagnostic and therapeutic approach to this disorder.