The Impact of Atopy on Neutrophil Activity in Middle Ear Effusion From Children and Adults With Chronic Otitis Media
David S. Hurst, MD, PhD;
Per Venge, MD, PhD
Arch Otolaryngol Head Neck Surg. 2002;128:561-566.
Objective To identify the relationship of neutrophil activity to allergy as reflected
by the level of myeloperoxidase (MPO) in ears of atopic patients with chronic
otitis media with effusion (OME) by objective testing.
Design Evidence of neutrophils was measured in the effusion of atopic patients
with chronic OME. Atopy was determined by intradermal and/or in vitro testing
of allergic reaction to 10 inhalants, 2 molds, and 5 foods.
Subjects Effusion MPO was measured prospectively in 138 ears from 106 consecutive
patients with chronic OME.
Results A total of 86 (81%) of 106 patients with OME tested atopic by in vitro
or in vivo testing. Excluding 36 ears with purulence, the mean MPO level was
3132 µg/L in 84 atopic vs 142 µg/L in 18 nonatopic ears (P<.001). A total of 78 (90%) of 87 patients with OME
were atopic.
Conclusions The surprising finding of marked elevation of effusion MPO in atopic
patients but very low levels in nonatopic patients (P<.001)
suggests that atopy may contribute to elevated levels of neutrophil activity
in OME. An atopic patient may respond differently from a nonatopic one to
the microbial or viral products of acute inflammation owing to the presence
of primed inflammatory cells. This study provides confirmation on a cellular
level that neutrophils are an integral part of the inflammatory process in
OME to a disproportionate degree among atopic patients.
From the Laboratory for Inflammation Research, Department of Medical
Sciences, University Hospital, Uppsala University, Uppsala, Sweden (Dr Venge).
Dr Hurst is in private practice in Farmington, Me.
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