Nasal hypersensitivity in purulent middle ear effusion

Area of Science:

• Otolaryngology
• Allergy and Immunology
• Respiratory Medicine

Background:

• A strong physiopathologic link between nasal and middle ear function is recognized.
• Chronic purulent middle ear effusion (CPMEE) is often expected to correlate with nasal disease, but this is less common in practice.
• Inadequate nasal function evaluation may explain the discrepancy between expected and observed associations.

Purpose of the Study:

• To investigate the incidence and types of nasal disorders in patients with CPMEE.
• To evaluate the relationship between nasal pathology and the presence of CPMEE.
• To explore the role of non-specific nasal hypersensitivity in the chronicity of CPMEE.

Main Methods:

• A cohort of 35 patients with CPMEE underwent comprehensive ENT evaluation.
• Methods included clinical history, physical examination, nasal endoscopy, rhino-rheo-manometry, histamine provocation tests, mucociliary transport tests, and allergy skin tests.
• Comparison was made with a control group of 10 healthy subjects for mucociliary transport time.

Main Results:

• A high prevalence of nasal disorders was observed: 26 patients had chronic rhinopathies, 24 had nasal septum deviation, and 31 had turbinate hypertrophy.
• CPMEE was frequently ipsilateral to nasal septum deviation (p < .001) and turbinate hypertrophy (p < .05).
• Elevated nasal resistance and impaired mucociliary transport were noted in CPMEE patients, with 96% of non-allergic individuals showing non-specific nasal hypersensitivity.

Conclusions:

• Non-specific nasal hypersensitivity is prevalent in patients with CPMEE and may contribute to Eustachian tube dysfunction.
• Recurrent inflammatory responses in the nasal cavity can lead to Eustachian tube obstruction, impairing middle ear ventilation.
• Comprehensive nasal evaluation is crucial for understanding and managing CPMEE, highlighting the nose-ear connection.