Eosinophilic Intolerance Otitis -An underestimated differential diagnosis of otorrhoea

Introduction The eosinophilic intolerance otitis has in its etiology and pathogenesis similarities with the chronic rhinosinusitis with polyposis with eosinophilic reaction. The correct diagnostic procedures and the treatment of the intolerance otitis represent a challange for ENT physicians in private practice as well as in hospitals.

Methods 90 Patients with chronic otitis media without cholesteatom in the diagnosis. The eosinophils count, the lymphocyte and the concentration of IgE were determined. Further inclusion criteria were known ASS intolerance in the medical report and chronic rhinosinusitis with polyposis. Patients received systemic antiallergic therapy with desloratadine 5 mg, possibly with leukotriene B4 antagonist, montelucast, at a dose of 10 mg daily. Tympanoplasty to improve hearing was performed after indication.

Result: The pathohistological evaluation showed a chronic inflammation with eosinophilia, as we usually find in a chronic rhinosinusitis with polyposis. The serological tests showed an evidence for an IgE mediated reaction. Conservative therapy with desloratadine and/or montelucast as well as tympanoplasty led to improved hearing and long-lasting improvements of the disease in most patients.

Conclusion Intolerance Otitis represents a diagnostic and therapeutic challenge. Otosurgical treatment can be performed in severe cases if conservative treatment is not sufficient. Equally important is the compliance of patients who require long-term conservative therapy.

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Publication History

Article published online:
10 June 2020