Inflammatory mediators in chronic otitis media with effusion.

Otitis media with effusion (OME) is a common middle ear inflammatory disease in the pediatric population. This article determines concentrations of three functionally and metabolically distinct inflammatory mediators in middle ear effusions (MEE) and corresponding plasma of children with OME. One hundred two patients (mean age, 4.9 years) with persistent OME were studied. Middle ear effusions were collected from all subjects and plasma from a subset at the time of tympanostomy tube insertion. Histamine was assayed radioisotopically, 13,14-dihydro-15-keto-prostaglandin F2 alpha (stable PGF2 alpha metabolite) by radioimmunoassay, and neutrophil chemotactic factor of anaphylaxis by modified Boyden chamber. Mean MEE levels of the mediators (39 +/- 13 ng/mL, 462 +/- 179 pg/mL, and 264% +/- 57% positive control, respectively) were markedly higher than those of corresponding plasma (0.5 +/- 0.1 ng/mL, 285 +/- 127 pg/mL, and 47% +/- 5% positive control, respectively). The mean histamine content of mucoid effusions (43.2 +/- 56.9 ng/mL) was significantly higher than that of purulent (22.5 +/- 10.5 ng/mL) and serous (17.9 +/- 16.8 ng/mL) effusions. Higher histamine levels were observed in effusions positive for Haemophilus influenzae when compared with those with other pathogenic isolates. The high concentrations of these mediators in MEE and their potential for inducing or sustaining the inflammatory process supports a role in the pathogenesis of OME.

Effect of an antihistamine/decongestant on nasal and eustachian tube function following intranasal pollen challenge.

Ten adult subjects with documented ragweed allergic rhinitis underwent progressive intranasal allergen challenge following pretreatment with either an antihistamine/decongestant or placebo in a double-blind crossover fashion. Objective measurements of nasal and Eustachian tube (ET) function were made following each challenge dose using posterior rhinomanometry and sonotubometry. The percent decrease in nasal airway function, expressed as a change in conductance, was significantly less in the drug pretreatment tests when compared with placebo pretreatment. Eustachian tube function was also significantly improved by antihistamine/decongestant pretreatment as 13 of the 20 ET were obstructed at a higher antigen dose following drug pretreatment when compared with placebo. These results demonstrate a role for antihistamine/decongestant preparations in the treatment of allergic rhinitis as well as for potential allergen-induced ET dysfunction.