MEDLINE Abstracts: Relation of Otitis Media to Rhinitis in Children
What is the connection between otitis media and allergic rhinitis? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Pulmonary Medicine.
Fireman P
Allergy & Asthma Proceedings 18(3):135-43, 1997 May-Jun
Otitis media is a multifactorial illness that is the most common childhood disease that requires physician care, and its resultant health care costs are high. The established role of infection in the pathogenesis of otitis media has promoted aggressive antimicrobial therapy with specific antibiotic protocols for acute otitis and prophylactic antibiotic regimens for chronic or recurrent acute otitis media. Even though these antibiotic regimens have been widely used, there has not been a decreased incidence of otitis media and its complications. The possibility that allergy contributes to chronic or recurrent otitis media especially in children older than 3 years has been debated for years. If a causal relationship between allergic respiratory diseases and middle ear disease were to be established, then one would anticipate that anti-allergic therapy would reduce the morbidity and health care costs associated with otitis media.
Fireman P
Journal of Allergy & Clinical Immunology 99(2):S787-97, 1997 Feb
Otitis media and otitis media with effusion are among the most common childhood illnesses and contribute a great deal to health care costs. The cause of otitis media is multifactorial. Eustachian tube dysfunction, bacterial or viral infection of the middle ear, and nasal inflammation resulting from allergic rhinitis or upper respiratory infection are acknowledged contributing factors. Data from epidemiology studies indicate that 25% to 40% of upper respiratory infections in children younger than 3 years are accompanied by an episode of otitis media, 40% to 50% of children older than 3 years with chronic otitis media have confirmed allergic rhinitis. Studies of the pathogenesis of otitis media have identified interactions among infection, allergic reactions, and eustachian tube dysfunction. Nasal inflammation due to allergen challenge results in classic signs and symptoms of allergic rhinitis and eustachian tube dysfunction. Eustachian tube dysfunction leads to increased negative pressure in the middle ear and improper ventilation. Both viral upper respiratory infection and nasal allergic reaction provoke nasal inflammation, eustachian tube dysfunction, and enhanced nasal protein transudation and secretion, which is likely to be sustained and modulated by inflammatory mediators and cytokines. In a study of experimental infection with influenza A virus, histamine release increased from peripheral blood basophils of patients with allergic rhinitis. These data support an interaction between viral infection and nasal allergy in enhancing certain pathophysiologic responses. Viral upper respiratory infections may promote secondary bacterial infections by altering bacterial adherence, modulating host immune and inflammatory responses, and impairing eustachian tube function. In acute otitis media, bacteria are cultured front approximately 70% of middle ear effusions with Streptococcus pneumoniae being the most common organism. Initial management of otitis media consists of appropriate antimicrobial therapy. In the presence of allergic rhinitis, antiallergic therapies may be used to augment symptom resolution and therapeutic response. Surgical insertion of tympanostomy or ventilation tubes to promote drainage of unresolved effusions has become common. Further delineation of the pathogenesis of otitis media and otitis media with effusion will guide appropriate medical management and may decrease the need and frequency of surgical procedures.
Fireman P
American Journal of Rhinology 11(2):95-102, 1997 Mar-Apr
Perennial and seasonal allergic rhinitis affect many million Americans and account for close to $2 billion annually in medical costs and lost productivity. The symptoms of allergic rhinitis, including sneezing, rhinorrhea, nasal congestion, and pruritus are, at best, very annoying and may be quite debilitating in some patients, causing irritability, insomnia, and fatigue. Moreover, allergic rhinitis is often not self-limiting and can contribute to serious medical complications such as sinusitis and otitis. Aggressive medical management of allergic rhinitis is important in the therapy for chronic sinusitis and otitis media and may prevent progression to more serious disease. Accurate diagnosis and initiation of environmental control measures to reduce exposure to causative factors should accompany initiation of pharmacotherapy. Antihistamines form the cornerstone of pharmacologic therapy, and use of the newer nonsedating antihistamines such as loratadine, terfenadine, and astemizole is not associated with the sedation produced by the classic antihistamines. Both loratadine and terfenadine are available in combination with a decongestant. Topical intranasal corticosteroids are another important component of pharmacologic management of allergic rhinitis. Allergen immunotherapy (hyposensitization) is used in those patients not adequately managed with pharmacotherapy. The relative safety and convenient dosing schedule of the newer medications should be accompanied by enhanced patient compliance and, hence, better control of allergic symptoms, halting progression of allergic rhinitis to serious medical complications.
Spector SL
Journal of Allergy & Clinical Immunology 99(2):S773-80, 1997 Feb
Allergic rhinitis affects approximately 20% of the U.S. population. An association between allergic rhinitis and conditions including asthma, sinusitis, otitis media, nasal polyposis, respiratory infections, and even orthodontic malocclusions has been observed. Clinical research has identified shared pathogenic mechanisms, epidemiologic correlations, and findings from allergy testing to indicate that these conditions represent long-term physical consequences in allergic individuals. The positive response of patients afflicted with these conditions to antiallergic treatment further enhances the association between allergic rhinitis and other airway diseases. The use of nasal corticosteroids in patients with rhinitis and asthma reduces not only rhinitis symptoms but also asthma symptoms and airway reactivity to methacholine challenge. Similarly, antihistamines, with or without decongestants, result in improvement of objective measurements of pulmonary function. In the treatment of acute sinusitis, the combination of an intranasal corticosteroid and an antibiotic provides greater benefit than an antibiotic alone. Treatment strategies for allergic rhinitis should be directed at controlling the symptoms of allergic rhinitis and reducing the development of physical complications in susceptible persons. Three techniques for the treatment of allergic rhinitis are used, including avoidance of offending allergens, selection of appropriate pharmaceuticals, and allergy immunotherapy. Appropriate treatment may spare some patients of related airway diseases and may also reduce the overall cost of care. The broadened scope of allergic rhinitis and increased prevalence of IgE-mediated diseases have heightened awareness regarding the profound consequences of allergic rhinitis and the importance of effective treatment.
What is the connection between otitis media and allergic rhinitis? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Pulmonary Medicine.
Fireman P
Allergy & Asthma Proceedings 18(3):135-43, 1997 May-Jun
Otitis media is a multifactorial illness that is the most common childhood disease that requires physician care, and its resultant health care costs are high. The established role of infection in the pathogenesis of otitis media has promoted aggressive antimicrobial therapy with specific antibiotic protocols for acute otitis and prophylactic antibiotic regimens for chronic or recurrent acute otitis media. Even though these antibiotic regimens have been widely used, there has not been a decreased incidence of otitis media and its complications. The possibility that allergy contributes to chronic or recurrent otitis media especially in children older than 3 years has been debated for years. If a causal relationship between allergic respiratory diseases and middle ear disease were to be established, then one would anticipate that anti-allergic therapy would reduce the morbidity and health care costs associated with otitis media.
Fireman P
Journal of Allergy & Clinical Immunology 99(2):S787-97, 1997 Feb
Otitis media and otitis media with effusion are among the most common childhood illnesses and contribute a great deal to health care costs. The cause of otitis media is multifactorial. Eustachian tube dysfunction, bacterial or viral infection of the middle ear, and nasal inflammation resulting from allergic rhinitis or upper respiratory infection are acknowledged contributing factors. Data from epidemiology studies indicate that 25% to 40% of upper respiratory infections in children younger than 3 years are accompanied by an episode of otitis media, 40% to 50% of children older than 3 years with chronic otitis media have confirmed allergic rhinitis. Studies of the pathogenesis of otitis media have identified interactions among infection, allergic reactions, and eustachian tube dysfunction. Nasal inflammation due to allergen challenge results in classic signs and symptoms of allergic rhinitis and eustachian tube dysfunction. Eustachian tube dysfunction leads to increased negative pressure in the middle ear and improper ventilation. Both viral upper respiratory infection and nasal allergic reaction provoke nasal inflammation, eustachian tube dysfunction, and enhanced nasal protein transudation and secretion, which is likely to be sustained and modulated by inflammatory mediators and cytokines. In a study of experimental infection with influenza A virus, histamine release increased from peripheral blood basophils of patients with allergic rhinitis. These data support an interaction between viral infection and nasal allergy in enhancing certain pathophysiologic responses. Viral upper respiratory infections may promote secondary bacterial infections by altering bacterial adherence, modulating host immune and inflammatory responses, and impairing eustachian tube function. In acute otitis media, bacteria are cultured front approximately 70% of middle ear effusions with Streptococcus pneumoniae being the most common organism. Initial management of otitis media consists of appropriate antimicrobial therapy. In the presence of allergic rhinitis, antiallergic therapies may be used to augment symptom resolution and therapeutic response. Surgical insertion of tympanostomy or ventilation tubes to promote drainage of unresolved effusions has become common. Further delineation of the pathogenesis of otitis media and otitis media with effusion will guide appropriate medical management and may decrease the need and frequency of surgical procedures.
Fireman P
American Journal of Rhinology 11(2):95-102, 1997 Mar-Apr
Perennial and seasonal allergic rhinitis affect many million Americans and account for close to $2 billion annually in medical costs and lost productivity. The symptoms of allergic rhinitis, including sneezing, rhinorrhea, nasal congestion, and pruritus are, at best, very annoying and may be quite debilitating in some patients, causing irritability, insomnia, and fatigue. Moreover, allergic rhinitis is often not self-limiting and can contribute to serious medical complications such as sinusitis and otitis. Aggressive medical management of allergic rhinitis is important in the therapy for chronic sinusitis and otitis media and may prevent progression to more serious disease. Accurate diagnosis and initiation of environmental control measures to reduce exposure to causative factors should accompany initiation of pharmacotherapy. Antihistamines form the cornerstone of pharmacologic therapy, and use of the newer nonsedating antihistamines such as loratadine, terfenadine, and astemizole is not associated with the sedation produced by the classic antihistamines. Both loratadine and terfenadine are available in combination with a decongestant. Topical intranasal corticosteroids are another important component of pharmacologic management of allergic rhinitis. Allergen immunotherapy (hyposensitization) is used in those patients not adequately managed with pharmacotherapy. The relative safety and convenient dosing schedule of the newer medications should be accompanied by enhanced patient compliance and, hence, better control of allergic symptoms, halting progression of allergic rhinitis to serious medical complications.
Spector SL
Journal of Allergy & Clinical Immunology 99(2):S773-80, 1997 Feb
Allergic rhinitis affects approximately 20% of the U.S. population. An association between allergic rhinitis and conditions including asthma, sinusitis, otitis media, nasal polyposis, respiratory infections, and even orthodontic malocclusions has been observed. Clinical research has identified shared pathogenic mechanisms, epidemiologic correlations, and findings from allergy testing to indicate that these conditions represent long-term physical consequences in allergic individuals. The positive response of patients afflicted with these conditions to antiallergic treatment further enhances the association between allergic rhinitis and other airway diseases. The use of nasal corticosteroids in patients with rhinitis and asthma reduces not only rhinitis symptoms but also asthma symptoms and airway reactivity to methacholine challenge. Similarly, antihistamines, with or without decongestants, result in improvement of objective measurements of pulmonary function. In the treatment of acute sinusitis, the combination of an intranasal corticosteroid and an antibiotic provides greater benefit than an antibiotic alone. Treatment strategies for allergic rhinitis should be directed at controlling the symptoms of allergic rhinitis and reducing the development of physical complications in susceptible persons. Three techniques for the treatment of allergic rhinitis are used, including avoidance of offending allergens, selection of appropriate pharmaceuticals, and allergy immunotherapy. Appropriate treatment may spare some patients of related airway diseases and may also reduce the overall cost of care. The broadened scope of allergic rhinitis and increased prevalence of IgE-mediated diseases have heightened awareness regarding the profound consequences of allergic rhinitis and the importance of effective treatment.
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