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Chronic Otitis Media: Overview, Diagnosis, and Treatment
About Chronic Otitis Media
Chronic serous otitis media (CSOM) may be defined as a middle ear effusion without perforation that is reported to persist for more than one to three months.1
Although most of the problems with chronic serous otitis media are associated with infections, allergic sensitizations can be a risk factor for recurrent episodes of the illness. It is thought that approximately 20 percent of patients with chronic serous otitis media have a contributing underlying allergy.2 There is also a significant correlation between chronic otitis media and allergic disease.3
Unfortunately, symptoms of otitis media with effusion (OME) are often exacerbated by coexisting allergies. To further complicate diagnosis and treatment is the fact that up to 80 percent of patients with allergies are sensitized to more than one allergen.4
Paying close attention to a patient’s presenting symptoms can help steer you toward testing that can identify the relevant sensitizing allergens. This information may be able to help you outline a comprehensive management plan, which may include avoiding known allergens that can keep your patient below his or her symptom threshold.
20% of patients
Approximately 20 percent of patients with chronic otitis media have an underlying allergy.2
- Persistent blockage of fullness of the ear
- Hearing loss
- Chronic ear drainage
- Development of balance problems
- Facial weakness
- Persistent deep ear pain or headache
- Fever
- Confusion or sleepiness
- Drainage or swelling behind the ear
Otitis media may not only cause severe pain, but also result in serious complication, including permanent hearing impairment, if it is not treated.15 If chronic otitis media is occurring alongside an allergy diagnosis, avoiding potential triggers can be, in and of itself, a promising management strategy.10
Diagnosing allergy in patients with chronic otitis media: Refining differential diagnosis through testing
An allergy-focused patient history6 can provide you with a more detailed history and allow you to effectively manage your patient.
Guided by the findings of your allergy-focused patient history, you may want to consider allergy testing as the most appropriate next step. Specific IgE blood tests, skin-prick tests (SPT), or both, are important diagnostic tools. Skin-prick testing and specific IgE blood measurements can help you rule in or rule out allergen sensitization, which may give you the ability to correctly diagnose and improve clinical management.7,8 The patient medical history should be supplemented by allergen sensitization testing for accurate results.9
Who should be tested?
There are several valid reasons why a specific IgE serological test should be considered if your patient is experiencing any symptoms. Allergic disease and eustachian tube dysfunction:10,11
- Increase inflammation
- Increase serous fluid production
- Provide a rich environment for infection
The symptom threshold
Up to 80 percent of patients with allergies are sensitized to more than one allergen.12 The effect is cumulative: An individual patient may have a number of triggers, which, combined, may lead to symptoms.13,14 The allergen symptom threshold is the point at which the cumulative allergen load leads to symptoms.13,14
Chronic otitis media and quality of life
Persistent chronic serous otitis media or recurrent acute otitis media may result in destructive changes in the middle ear. It can cause hearing loss or impaired hearing, which can interfere with language and speech development if it happens at critical times during a child’s life.1
Common allergens
Specific IgE serological tests aid in the diagnosis of allergic disease. As such, anyone presenting with chronic otitis media or other allergy symptoms is a candidate for specific IgE blood testing. Here are common allergens that can add up to symptoms:10
- Pollen
- House dust mite
- Animal dander
- Milk
- Mold
- Cockroach
- Egg
Testing Increases Diagnostic Confidence
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
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Management and care of patients with chronic otitis media
Determine how to reduce the exposure to allergic triggers and identify which long-term therapies may be best for their patients with allergy-based chronic otitis media. Otitis media may not only cause severe pain, but also result in serious complication, including permanent hearing impairment, if it is not treated.15 The underlying cause of chronic otitis media will likely dictate long-term management plan for patients with persistent symptoms.15,16 If chronic otitis media is occurring alongside an allergy diagnosis, avoiding potential triggers can be, in and of itself, a promising management strategy.10
Practice parameters have been developed to help guide the management and treatment of patients with otitis media.
For patients with chronic otitis media and comorbid allergic disease, exposure to allergic triggers and identification of long-term therapies should be based on the assessment of risk factors, including age and previously diagnosed allergeis.9
- Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M. Update on otitis media – prevention and treatment. Infection and Drug Resistance. 2014;7:15-24. doi:10.2147/IDR.S39637.
- Tomonaga, K, Kurono, Y, Mogi, G. The role of nasal allergy in otitis media with effusion. A clinical study. Acta Otolaryngol Suppl. 1988;458:41-47.
- Passali D, Passali GC, Lauriello M, Romano A, Bellussi L, Passali FM. Nasal Allergy and Otitis Media: A real correlation? Sultan Qaboos University Medical Journal. 2014;14(1):e59-e64.
- Ciprandi G, Alesina R, Ariano R, et al. Characteristics of patients with allergic polysensitization: the POLISMAIL study. Eur Ann Allergy Clin Immunol. 2008;40(3):77-83.
- https://www.umms.org/ummc/health-services/hearing-balance/services/ear-infections
- Pawankar R, Holgate S, Canonica G, at el. World Allergy Organization. White Book on Allergy (WAO). 2011. http://www.worldallergy.org/UserFiles/file/WAO-White-Book-on-Allergy_web.pdf. Accessed December 2017.
- Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl 78):35-41.
- Niggemann B, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by invitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331.
- Smith HE, Hogger C, Lallemant C, et al. Is structured allergy history sufficient when assessing patients with asthma and rhinitis in general practice? J Allergy Clin Immunol. 2009;123:646-650.
- Zernotti ME, et al. Otitis media with effusion and atopy: is there a causal relationship? World Allergy Organ J. 2017; 10(1):37
- Fireman P. Otitis media and eustachian tube dysfunction: connection to allergic rhinitis. J Allergy Clin Immunol. 1997 Feb;99(2):S787–S797
- Ciprandi G, Alesina R, Ariano R, et al. Characteristics of patients with allergic polysensitization: the POLISMAIL study. Eur Ann Allergy Clin Immunol. 2008;40(3):77-83.
- Eggleston PA. Control of environmental allergens as a therapeutic approach. lmmunol Allergy Clin North Am. 2003;23(3):533-547.
- Wickman M. When allergies complicate allergies. Allergy. 2005;60 (suppl 79):14-18.
- World Health Organization: Chronic suppurative otitis media Burden of Illness and Management Options. http://www.who.int/pbd/publications/Chronicsuppurativeotitis_media.pdf. Accessed April 2019.
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