Improvement of Eosinophilic Otitis Media by Optimized Asthma Treatment
A 58-year-old Japanese female patient with adult-onset asthma first visited our ear, nose, and throat clinic at Tokyo Women's Medical University in August 1999 at age 46 years with complaints of a feeling of fullness in both ears that started in July 1999. On examination, we observed glue like otorrhea from the edges of the bilateral perforated tympanic membranes (). Marked eosinophilia was detected in the sticky otorrhea and the tympanic cavity granulomas. The peripheral blood eosinophil percentage was 8.0%, and the serum IgE level was 56 IU/mL. Capsulated hydrophobic carrier polymer-radioallergosorbent tests were positive only for Japanese cedar pollen. We diagnosed the patient with EOM. Treatment was started and continued for 11 years by instilling 0.1% betamethasone disodium phosphate solution (Rinderon) into the bilateral tympanic cavities. However, her ear symptoms did not improve after this treatment. She was diagnosed with asthma at age 43 years (1996) shortly after the first asthma attack. The diagnosis of asthma was made by a respiratory physician based on a comprehensive history of repeated bouts of coughing, wheezing, breathlessness, and chest tightness, as well as a clinical examination, including chest auscultation and pulmonary function tests. Her asthma was treated with montelukast (10 mg once daily) and inhaled fluticasone propionate (FP; 200 µg twice daily). Three years later, at the time of her first visit to the Department of Otolaryngology, she was still taking montelukast and inhaled FP therapy for her asthma, and we continued this regimen.\nDespite the asthma treatment with inhaled FP (200 µg, b.i.d.), she continued to have two to three asthma attacks per year. She again consulted a respiratory specialist at the age of 57 years (July 2010), and the asthma treatment was stepped up to a combination of inhaled FP (250 µg) and salmeterol 50 µg (FSC) (Advair Diskus® 250/50; GlaxoSmithKline). Montelukast was continued at 10 mg/day, but the intratympanic instillation of 0.1% betamethasone disodium phosphate solution (Rinderon) was discontinued. Two months after changing the treatment to the combination of inhaled steroid and long-acting β2 agonists, her asthma was under control, and both the otorrhea and granulomas disappeared (). In September 2010, the percentage of peripheral blood eosinophils decreased to 3.2%, whereas the level of serum IgE remained largely unchanged at 55.1 IU/mL. Conductive hearing loss, which had been detected by pure-tone audiometry performed prior to the introduction of this combination therapy, improved thereafter (). The soft-tissue shadows assessed by computed tomography also improved following the stepped-up asthma treatment (). For more than 1 year thereafter, there has been no recurrence of otorrhea or granuloma formation and no deterioration of the acuity of hearing.