Allergic Rhinitis in Adults with Chronic Suppurative Otitis Media

Document Type : Original


1 Sinonasal Diseases Research Centre, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.

2 Department of Immunology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

3 PhD Candidate, Department of Epidemiology, School of Public Health, Shahid Beheshti University of medical sciences, Tehran, Iran.

4 Department of Otolaryngology, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.


Chronic suppurative otitis media (CSOM) is considered one of the most common causes of acquired hearing impairment in developing countries. CSOM is a multifactorial persistent inflammatory disease of the middle ear. A distinct pathophysiologic mechanism linking allergic rhinitis (AR) and CSOM remains to evolve. The purpose of this study was to investigate the association between AR and CSOM in adults.This was a case-control study.
Materials and Methods:
The subjects were 62 adults (23 male, 39 female) with established CSOM and 61 healthy controls.CSOM was diagnosed when there was a history of chronic (persisting for at least 3 months) otorrhea, accumulation of mucopurulent exudates in the external auditory canal or middle ear and/or perforated tympanic membrane on otoscopy. All participants were evaluated for the presence of AR by clinical evaluation of allergic symptoms, and underwent a skin-prick test for 23 common regional allergens. Statistical analysis was performed using SPSS version 16.
The prevalence of clinical rhinitis (allergic and non-allergic) was significantly higher among the cases compared with controls (62.5% vs. 37.5%, P=0.02). The prevalence of AR (proven by positive skin-prick test) was also significantly higher among affected adults than controls (24.6% and 13.8%, respectively). Adjusting for age, a logistic regression model showed that there was a significant difference between the two groups. Patients with AR and non-AR were at 3.27- (95% CI=1.15–9.29; P=0.036) and 2.57-(95% CI=1.01–6.57; P=0.048) fold increased risk of developing CSOM, respectively, compared with healthy individuals.
The study showed a higher prevalence of AR in CSOM patients than in controls. It may be valuable to evaluate and control this factor in these patients.


Main Subjects

1. Monasta L, Ronfani L, Marchetti F, Montico M, Brumatti LV, Bavcar A, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One 2010; 7(4): e36226.
2. Olatoke F, Ologe FE, Nwawolo CC, Saka MJ. The prevalence of hearing loss among school children with chronic suppurative otitis media in Nigeria, and its effect on academic performance. Ear Nose Throat J 2008; 87(12).
3. Acuin J. Chronic suppurative otitis media: burden of illness and management options. Geneva: World Health Organization 2004. Available at URL: http://www. who. int/ pbd/ deafness/activities/hearing_care/otitis_ media. pdf.
4. Vikram BK, Khaja N, Udayashankar SG, Venkatesha BK, Manjunath D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol 2008; 122(5):442–6.
5.  Gorgulu O, Ozelci M, Ozdemir S, Yasar M, kemal Olgun M, Kursat Arikan O. The role of allergy in the pathogenesis of chronic suppurative otitis media. Int Adv Oto 2012; 8(2): 276–81.
6. Acuin J. Chronic suppurative otitis media; Evidence Report. Clin Evid (Online) 2007
7. Zhang XH, Zhang YN, Liu Z. MicroRNA in chronic rhinosinusitis and allergic rhinitis. Curr Allergy Asthma Rep 2014;14(2):415.
8. Moussu L, Saint-Pierre P, Panayotopoulos V, Couderc R, Amat F, Just J. Determinants of allergic rhinitis in young children with asthma. PLoS One 2014;9(5):e97236.
9. Hom MM, Bielory L. The anatomical and functional relationship between allergic conjunctivitis and allergic rhinitis. Allergy Rhinol (Providence) 2013;4(3):e110–9.
10. Darlenski R, Kazandjieva J, Hristakieva E, Fluhr W. Atopic dermatitis as a systemic disease. Clin Dermatol 2014; 32(3):409–13.
11.  Saberi A, Nemati S, Shakib RJ, Kazemnejad E, Maleki MB. Association between allergic rhinitis and migraine. J Res Med Sci 2012;17(6):508–12.
13. Yeo SG, Park DC, Eun YG, Cha C. The role of allergic rhinitis in the development of otitis media with effusion: effect on Eustachian tube function. Am J Otolaryngol 2007; 28(3):148–52.
14. Lack G, Caulfield H, Penagos M. The link between otitis media with effusion and allergy: a potential role for intranasal corticosteroids. Pediatr Allergy Immunol 2011;22(3):258–66.
15. Lazo-Saenz JG, Galvan-Aguilera AA, Martinez-Ordaz VA, Velasco-Rodriguez VM, Nieves Renteria A, Rincon Castaneda C. Eustachian tube dysfunctionin allergic rhinitis. Otolaryngol Head Neck Surg 2005;132(4):626–29.
16. Luong A, Roland P. The link between allergic rhinitis and chronic otitis media with effusion in atopic patients. Otolaryngol Clin North Am 2008; 41(2):311–23.
17. Mion O, de Mello JF Jr, Lessa MM, Goto EY, Miniti A. The role of rhinitis in chronic otitis media. Otolaryngol Head Neck Surg 2003; 128(1): 27–31.
18. Lasisi A, Arinola O, Olayemi O. Role of elevated immunoglobulin E levels in suppurative otitis media. Ann Trop Paediatr 2008;28(2):123–7.
19. Bousquet J, Reid J, Van Weel C, Baena Cagnani C, Canonica GW, Demoly P, et al. Allergic rhinitis management pocket reference. Allergy 2008;63(8):990–6.
20. Alles R, Parikh A, Hawk L, Darby Y, Romero JN, Scadding G. The prevalence of atopic disorders in children with chronicotitis media with effusion. Pediatr Allergy Immunol 2001; 12(2):102–6.
21. Umapathy D, Alles R, Scadding GK. A community based questionnaire study on the association between symptoms suggestive of otitis media with effusion, rhinitis and asthma in primary school children. Int J Pediatr Otorhinolaryngol 2007; 71(11):705–12.
22. Hong SD, Cho YS, Hong SH, Chung HW,  Chung KW. Chronic otitis media and immunoglobulin E-mediated hypersensitivity in adults: is it a contributor of cholesteatoma? Otolaryngol Head Neck Surg 2008;138(5): 637–40.
23. Fliss DM, Shoham I, Leiberman A, Dagan R. Chronic suppurative otitis media without cholesteatoma in children in southern Israel: incidence and risk factors. Pediatr Infect Dis J 1991; 10(12):895–99.
24. Bakhshaee M, Rajati M, Fereidouni M, fereidouni M, Khadivi E, Varasteh A. Allergic rhinitis and chronic suppurative otitis media. Eur Arch Otorhinolaryngol 2011; 268: 87–91.
25. Wallace DV, Dykewicz MS, Bernstein D, Blessing Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol 2008; 122 (2):S1–84.
26. Settipane RA. Rhinitis: A dose of epidemiological reality. Allergy Asthma Proc 2003; 24(3):147–54.
27. Caffarelli C, Savini E, Giordano S, Cavagni. Atopy in children with otitis media with effusion. Clin Exp Allergy 1998; 28(5): 591–6.
28. Ghaffari J, Khademloo M, Saffar MJ, Rafiei AR, Masiha F. Hypersensitivity to house dust mite and cockroach is the most common allergy in north of Iran. Iran J Immunol 2010;7(4):234–9.