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Current Allergy and Asthma Reports
Published in: Current Allergy and Asthma Reports 7/2023

03-07-2023 | Eustachian Tube Dysfunction

Pathophysiological Link Between Chronic Rhinosinusitis and Ear Disease

Authors: Christian Calvo-Henriquez, Eugenio Di Corso, Isam Alobid, Elena Cantone, Tiziana Di Cesare, Joaquim Mullol

Published in: Current Allergy and Asthma Reports | Issue 7/2023

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Abstract

Purpose of Review

In the clinical practice, patients affected by chronic rhinosinusitis (CRS) commonly complain of otologic symptoms. This review aims to describe the available literature evidence assessing the relationship between CRS and ear illnesses published in the last 5 years.

Recent Findings

Available evidence suggests a higher prevalence of otologic symptoms in patients suffering from CRS, affecting up to 87% of patients. These symptoms may be related to Eustachian tube dysfunction, which improves after treatment for CRS. A few studies suggested a potential but not confirmed role of CRS in cholesteatoma, chronic otitis media, and sensorineural hypoacusis. A special type of otitis media with effusion (OME) may occur in patients with CRS, which seems to respond well to new biologic therapy.

Summary

Ear symptoms appear to be highly prevalent in patients with CRS. So far, the available evidence is robust only for Eustachian tube dysfunction, which has been shown to be particularly impaired in CRS patients. Additionally, the Eustachian tube function appears to improve after treatment for CRS. Finally, interesting preliminary data were described for eosinophilic otitis media, as it appears to respond well to the treatment with biologics.
Literature
1.
Ahmad JG, Marino MJ, Luong AU. Unified airway disease: future directions. Otolaryngol Clin North Am. 2023;56(1):181–95.CrossRefPubMed
2.
Maniakas A, Desrosiers M, Asmar MH, Al Falasi M, Endam LM, Hopkins C, et al. Eustachian tube symptoms are frequent in chronic rhinosinusitis and respond well to endoscopic sinus surgery. Rhinology. 2018;56(2):118–21.CrossRefPubMed
3.
Chang MT, Hosseini DK, Song SH, Nayak JV, Patel ZM, Lee JY, et al. The effect of endoscopic sinus surgery on Eustachian tube dysfunction symptoms. Otolaryngol Head Neck Surg. 2020;163(3):603–10.CrossRefPubMed
4.
Teo NW, Mace JC, Smith TL, Hwang PH. Impact of endoscopic sinus surgery on otologic symptoms associated with chronic rhinosinusitis. World J Otorhinolaryngol Head Neck Surg. 2017;3(1):24–31.CrossRefPubMedPubMedCentral
5.
• Chen T, Shih MC, Edwards TS, Nguyen SA, Meyer TA, Soler ZM, et al. Eustachian tube dysfunction (ETD) in chronic rhinosinusitis with comparison to primary ETD: a systematic review and meta-analysis. Int Forum Allergy Rhinol. 2022;12(7):942–51. Up to date, this is the only metanalysis assessing eustachian tube dysfunction in chronic rhinosinusitis.
6.
Cole RA. Chronic otitis media, mastoiditis and petrositis. In: Cummings Otolaryngology Head and Neck Surgery. 6th ed. Philadelphia: Elsevier; 2015. p. 2139–55.
7.
8.
Singh GB, Malhotra S, Yadav SC, Kaur R, Kwatra D, Kumar S. The role of biofilms in chronic otitis media-active squamosal disease: an evaluative study. Otol Neurotol. 2021;42(9):e1279–85.CrossRefPubMed
9.
Kim SK, Park MW, Min C, Park IS, Park B, Byun SH, et al. Increased risk of chronic otitis media in chronic rhinosinusitis patients: a longitudinal follow-up study using a national health screening cohort. Rhinology. 2021;59(3):292–300.PubMed
10.
Hong SN, Lee WH, Lee SH, Rhee CS, Lee CH, Kim JW. Chronic rhinosinusitis with nasal polyps is associated with chronic otitis media in the elderly. Eur Arch Otorhinolaryngol. 2017;274(3):1463–70.CrossRefPubMed
11.
Son DS, Cho MS, Kim DK. Chronic rhinosinusitis could increase the risk of cholesteatoma of middle ear. Int Forum Allergy Rhinol. 2023;13(2):168–71.CrossRefPubMed
12.
Kuo CL, Yen YC, Chang WP, Shiao AS. Association between middle ear cholesteatoma and chronic rhinosinusitis. JAMA Otolaryngol Head Neck Surg. 2017;143(8):757–63.CrossRefPubMedPubMedCentral
13.
Chen WC, Yang KL, Lin WC, Fang KC, Wu CN, Luo SD. Clinical outcomes of Eustachian tube dysfunction in chronic rhinosinusitis following endoscopic sinus surgery. J Chin Med Assoc. 2022;85(7):782–7.CrossRefPubMed
14.
Choi KY, Jang S, Seo G, Park SK. Effect of endoscopic sinus surgery on Eustachian tube function in adult sinusitis patients: a prospective case-control study. J Clin Med. 2021;10(20):4689.CrossRefPubMedPubMedCentral
15.
Wu AW, Walgama ES, Higgins TS, Borrelli M, Vardanyan N, Hopp S, et al. Eustachian tube quality of life and severity of disease in patients with chronic rhinosinusitis. Am J Rhinol Allergy. 2020;34(4):532–6.CrossRefPubMed
16.
Higgins T, Cappello Z, Wu AW, Ting JY, Sindwani R. Predictors of eustachian tube dysfunction improvement and normalization after endoscopic sinus surgery. Laryngoscope. 2020;130(12):E721–6.CrossRefPubMed
17.
Schilder AGM, Bhutta MF, Butler CC, Holy C, Levine LH, Kvaerner KJ, et al. Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol. 2015;40(5):407–11.CrossRefPubMedPubMedCentral
18.
Smith ME, Tysome JR. Tests of Eustachian tube function: a review. Clin Otolaryngol. 2015;40(4):300–11.CrossRefPubMed
19.
Vandersteen C, Castillo L, Roger C, Savoldelli C, Guevara N. Tubomanometry: an effective and promising assessment of Eustachian tube dysfunction in chronic rhinosinusitis patients. Eur Ann Otorhinolaryngol Head Neck Dis. 2021;138(1):7–12.CrossRefPubMed
20.
Tangbumrungtham N, Patel VS, Thamboo A, Patel ZM, Nayak JV, Ma Y, et al. The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2018;8(5):620–3.CrossRefPubMed
21.
Daval M, Picard H, Bequignon E, Bedbeder P, Coste A, Ayache D, et al. Chronic otitis media with effusion in chronic sinusitis with polyps. Ear Nose Throat J. 2018;97(8):E13–8.CrossRefPubMed
22.
Chen X, Dang H, Chen Q, Chen Z, Ma Y, Liu X, et al. Endoscopic sinus surgery improves Eustachian tube function in patients with chronic rhinosinusitis: a multicenter prospective study. Rhinology. 2021;59(6):560–6.CrossRefPubMed
23.
Lyly A, Genberg E, Kauppi P, Virkkula P, Lee SE, Laidlaw TM, et al. Real-life experience of biologic treatment for asthma on chronic rhinosinusitis: a Finnish cohort. Int Arch Allergy Immunol. 2022;7:1–12.
24.
Ohta N, Ishida A, Kurakami K, Suzuki Y, Kakehata S, Ono J, et al. Expressions and roles of periostin in otolaryngological diseases. Allergol Int. 2014;63(2):171–80.CrossRefPubMed
25.
•• Bartier S, Béquignon E, Thibaut de Ménonville C, Verillaud B, Evrard D, Léger M, et al. Otitis media in severe asthma associated with chronic rhinosinusitis with nasal polyps: a new therapeutic target for biologics. J Asthma. 2022;1–6. This study has the largest sample size reporting the use of biologic therapy to treat eosinophilic otitis media, an illness currently no recognized as indication for biologic therapy.
26.
• Iino Y, Tomioka-Matsutani S, Matsubara A, Nakagawa T, Nonaka M. Diagnostic criteria of eosinophilic otitis media, a newly recognized middle ear disease. Auris Nasus Larynx. 2011;38(4):456–61. This study is the basis for the diagnosis of eosinophilic otitis media.
27.
Ohira S, Komori M, Matsui H, Furuya H, Kajiwara R, Matsuura K, et al. Anatomical features around Eustachian tube in eosinophilic otitis media with eosinophilic sinusitis. Laryngoscope. 2021;131(10):E2689–95.CrossRefPubMed
28.
Yoshida N. Intractable otitis media - pathogenesis and treatment of Eosinophilic otitis media (EOM) and otitis media with antineutrophil cytoplasmic antibody (ANCA) -associated vasculitis (OMAAV). Auris Nasus Larynx. 2022;S0385–8146(22):00191–2.
29.
Shevchik E, Svistushkin V, Nikiforova G, Zolotova A. Eosinophilic otitis media: modern aspects of pathogenesis, clinical features, diagnosis and treatment. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 1):132–40.CrossRefPubMed
30.
31.
•• De Corso E, Montuori C, Settimi S, Mele DA, Cantiani A, Corbò M, et al. Efficacy of biologics on refractory eosinophilic otitis media associated with bronchial asthma or severe uncontrolled CRSwNP. J Clin Med. 2022;11(4):926. This study has the second largest sample size reporting the use of biologic therapy to treat eosinophilic otitis media, however is the largest using a specific questionnaire to assess chronic otitis media response.
32.
Kagoshima H, Hori R, Kojima T, Okanoue Y, Tagushi A, Yamamoto H, et al. Successful treatment of eosinophilic chronic rhinosinusitis and eosinophilic otitis media using the anti-IL-5 receptor monoclonal antibody benralizumab: a case report. Respir Med Case Repo. 2020;17(30): 101135.
33.
Shimizu H, Kato H, Yoshioka S, Okazawa M. Rapid and remarkable effectiveness of benralizumab for treating severe bronchial asthma with intractable eosinophilic rhinosinusitis and eosinophilic otitis media: a case report. Respir Med Case Rep. 2021;32:101336.PubMed
34.
Chikumoto A, Oishi K, Hamada K, Hirano T, Kakugawa T, Kanesada K, et al. Sequential biotherapy targeting IL-5 and IL-4/13 in patients with eosinophilic asthma with sinusitis and otitis media. Biomolecules. 2022;12(4):522.CrossRefPubMedPubMedCentral
35.
van der Lans RJL, van Spronsen E, Fokkens WJ, Reitsma S. Complete remission of severe eosinophilic otitis media with dupilumab: a case report. Laryngoscope. 2021;131(12):2649–51.CrossRefPubMedPubMedCentral
36.
Iino Y, Sekine Y, Yoshida S, Kikuchi S. Dupilumab therapy for patients with refractory eosinophilic otitis media associated with bronchial asthma. Auris Nasus Larynx. 2021;48(3):353–60.CrossRefPubMed
37.
Gill AS, Hwang J, Beliveau AM, Alt JA, Strong EB, Wilson MD, et al. The impact of medical comorbidities on patient satisfaction in chronic rhinosinusitis. Ann Otol Rhinol Laryngol. 2021;12:34894211015736.
38.
Lin X, Shan X, Lin S, Shu B, Wang Y, Xiao W. Is Sensorineural hearing loss related to chronic rhinosinusitis caused by outer hair cell injury? Med Sci Monit. 2019;22(25):627–36.CrossRef
Metadata
Title
Pathophysiological Link Between Chronic Rhinosinusitis and Ear Disease
Authors
Christian Calvo-Henriquez
Eugenio Di Corso
Isam Alobid
Elena Cantone
Tiziana Di Cesare
Joaquim Mullol
Publication date
03-07-2023
Publisher
Springer US
Published in
Current Allergy and Asthma Reports / Issue 7/2023
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-023-01072-3

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