Role of elevated immunoglobulin E levels in suppurative otitis media.

Background And Objectives: An association between suppurative otitis media (SOM) and allergy has been reported in about 80% of patients with allergy. However, there is controversy regarding their relationship and the concept of middle-ear allergic response. We test the hypothesis that increased secretion of IgE in the middle ear is higher in chronic than in acute SOM.

Methods: Allergy skin testing and enzyme-linked immunoassay of specimens of middle-ear secretions and sera were analysed.

Results: Paired sera and middle-ear secretions (MES) from 37 subjects with SOM, 20 chronic (CSOM) and 17 acute (ASOM), and sera of 15 controls selected from children without otitis media were analysed. There were 30 males and 27 females aged between 6 months and 9 years, mean (SD) 6 years (3.26). A history of allergy and skin test positive to one or more of dust, house dust mite, mould, cockroach and poultry feathers were found in 80% of CSOM, 47% ASOM and 33% controls. The mean IgE levels in sera were: controls 52.1 mg/dL, ASOM 63.9 mg/dL and CSOM 79.2 mg/dL; the MES levels were: AOM 60.4 mg/dL and CSOM 102.0 mg/dL. The MES to serum IgE ratios were 0.75 for ASOM and 1.4 for CSOM. The serum IgE ratio of controls to ASOM was 1.22 and to CSOM was 1.5. Multivariate analysis of the mean showed significant correlation between IgE level of MES in ASOM and CSOM (p=0.04) but no correlation between IgE levels in control and ASOM sera (p=0.10), control and CSOM sera (p=0.7) or AOM and CSOM sera (p=0.3).

Conclusion: Allergy appears to play a contributory role in CSOM and elevated IgE in the MES suggests a likely mucosal response.