Similar Allergic Inflammation in Middle Ear and Upper Airway
Bibliographic record
Abstract
Source: Nguyen LHP, Manoukian JJ, Sobol SE, et al. Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. J Allergy Clin Immunol. 2004;114:1110–1115Children with otitis media with effusion have an increased prevalence of atopic diseases.1 Airways in children with allergic rhinitis and those with asthma demonstrate similar inflammatory markers,2 suggesting that these 2 conditions represent different manifestations of a single inflammatory airway disease. Researchers from McGill University in Montreal and the University of Pennsylvania compared the cellular and cytokine profiles of the nasopharynx and middle ear effusion (MEE) in atopic and non-atopic children.Forty-five consecutive children (age 2–18 years) who required myringotomy, tympanostomy tube placement, and adenoidectomy were enrolled in the study. All had MEE persisting for at least 3 months and symptomatic nasal obstruction from adenoidal hypertrophy. Children using corticosteroids within the previous 6 weeks and those with acute otitis media within 3 weeks were excluded, as were those found to have pus in the nasopharynx at the time of the procedure. Atopy was defined as a positive skin prick test to at least 1 of 12 common aeroallergens. Samples of the MEE, adenoid tissue, and biopsy specimens of the ipsilateral torus tubaris (nasopharyngeal mucosa near the Eustachian tube opening) were collected from study patients and evaluated for cellularity (eosinophils, T lymphocytes, and neutrophils) and the presence of messenger RNA for interleukin (IL)-4, IL-5, and interferon (IFN)-γ.Eleven of 45 children enrolled were atopic; the remainder served as non-atopic controls. The atopic group tended to be older (mean age 6.5 vs 5.3 years) and had a lower female-tomale ratio (1:2.7 vs 1:1). The MEE from atopic children had significantly more eosinophils and T cells than did the MEE of non-atopic controls. Similarly, the MEE of atopic patients had a higher percentage of IL-4 mRNA+ cells and IL-5 mRNA+ cells than did that of controls. Conversely, atopic children had significantly fewer neutrophils and fewer IFN-γ+ cells in their MEE than the non-atopic subjects. Compared to that of non-atopic controls, the adenoid tissue of atopic children contained significantly more eosinophils, more IL-4 and IL-5 mRNA+ cells, and fewer neutrophils and IFN-γ+ cells. There was no difference in the number of T cells between groups. Finally, when biopsies of the torus tubaris were examined, a similar pattern was observed. Atopic children had significantly more eosinophils, T cells, IL-4 mRNA+ cells, and IL-5 mRNA+ cells, with significantly fewer neutrophils than the controls. These findings establish that in atopic patients allergic inflammation is manifest in both the middle ear effusions and the tissues of the nasopharynx.Dr. Lester has disclosed no financial relationships relevant to this commentary.Every part of the airway is connected, at least indirectly, to every other part, leading to the concept of a “united airway.” Sinusitis, otitis, and asthma are co-morbid conditions of allergic rhinitis.1 Furthermore, control of allergic rhinitis can lead to improved control of recurrent upper airway bacterial infections3 and asthma.4 Eustachian tube dysfunction can be treated with an application of topical corticosteroid to the Eustachian orifice,5 suggesting an element of eosinophilic inflammation at the site in some patients.This study is the first to demonstrate the simultaneous presence of allergic inflammation at both ends of the Eustachian tube in allergic patients: in the middle ear and in the nasopharynx. The study demonstrates that the various conditions attributable to “allergic airways disease” cannot be fully understood by study of its manifestation in a single anatomic location.The results of this study demonstrate that an allergic response occurs in the middle ear of atopic children with MEE. The clinical implications of this finding are unclear; however, it may be that more aggressive treatment of allergic symptoms might reduce MEE, both by aiding in Eustachian tube dysfunction through treatment of allergic rhinitis as well as by reducing the allergic response in the middle ear itself. As the authors point out, if these results are validated in clinical trials, careful attention to the treatment of allergic conditions might obviate the need for surgery in many children with MEE.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".