title: Evidence of allergic inflammation in the middle ear and nasopharynx in atopic children with otitis media with effusion.
abstract: BACKGROUND
  Otitis media with effusion (OME) occurs in the setting of eustachian tube (ET) dysfunction. Previous studies have demonstrated a predominance of T helper 2 (Th2) mediators in the middle ear effusions (MEEs) of atopic children, suggesting that allergy plays a role in the pathogenesis of OME. Given that the middle ear is contiguous with the upper airway, the allergic inflammation seen in the middle ear of atopic patients with OME may also have been observed in the nasopharynx.
  
  
  OBJECTIVE
  We hypothesize that atopic children have different cellular and cytokine profiles in MEE compared with nonatopic patients and that this allergic inflammation occurs in both the middle ear and the nasopharynx.
  
  
  METHODS
  Forty-five patients undergoing both ventilation tube placement for OME and adenoidectomy for adenoid hypertrophy were recruited. The atopic status was determined for each patient using standard skin testing. The cellular and cytokine profiles of the MEEs and the torus tubarius and adenoid tissues were investigated using immunocytochemistry and in situ hybridization.
  
  
  RESULTS
  Our results indicate that, within the atopic patient, there is a similar cellular and cytokine profile within the three regions sampled, with a predominant expression of interleukin-4 (a Th2 cytokine) and an increased infiltration of eosinophils compared with the nonatopic patient.
  
  
  CONCLUSIONS
  These findings confirm the association of allergy with MEE and support the hypothesis that the middle ear may be an integral part of the United Airway Concept.
authors.affiliation: Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.
authors.forename: Lily H P
authors.initials: LH
authors.lastname: Nguyen
authors.forename: John J
authors.initials: JJ
authors.lastname: Manoukian
authors.forename: Ted L
authors.initials: TL
authors.lastname: Tewfik
authors.forename: Steven E
authors.initials: SE
authors.lastname: Sobol
authors.forename: Philippe
authors.initials: P
authors.lastname: Joubert
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Mazer
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Schloss
authors.forename: Rame
authors.initials: R
authors.lastname: Taha
authors.forename: Qutayba A
authors.initials: QA
authors.lastname: Hamid
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000276:immunology / Q000601:surgery; D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000453:epidemiology* / Q000276:immunology*; D004804:Eosinophils / Q000276:immunology*; D005064:Eustachian Tube / Q000276:immunology* / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D015847:Interleukin-4 / Q000276:immunology*; D008297:Male; D008876:Middle Ear Ventilation; D009305:Nasopharynx / Q000276:immunology* / Q000601:surgery; D010034:Otitis Media with Effusion / Q000453:epidemiology* / Q000276:immunology* / Q000601:surgery; D011446:Prospective Studies; D012882:Skin Tests; D018418:Th2 Cells / Q000276:immunology*
chemical_list: D000911:Antibodies, Monoclonal; D015847:Interleukin-4