Roger Friedman

Asthma and bacterial sinusitis in children

Signs, symptoms, and radiographic abnormalities of sinusitis are frequent in children with asthma; it is not known whether sinus inflammation is associated with bacterial infection or other mechanisms. Eight asthmatic patients with exacerbation of asthma despite bronchodilator therapy were studied after maxillary sinusitis was confirmed by radiographs. All had cough, wheezing, nasal stuffiness, rhinorrhea and were afebrile. Four patients had headaches, and two had facial pain. Maxillary sinus aspirates were obtained, and bacterial cultures were positive in five: Branhamella catarrhalis (2), nontypeable Hemophilus influenzae (2), Streptococcus pneumoniae (1). Nose and throat cultures did not correlate with sinus cultures. All patients received bronchodilators, and four of eight patients received steroids. All were treated for 14 to 28 days with antibiotics during which seven of the eight patients improved clinically including all with positive sinus cultures. Asthma-symptoms diary scores were kept by five; all demonstrated improvement. Pulmonary-function tests improved in five of seven patients after the antibiotic and asthma therapy including the four patients with positive cultures. Sinus radiographs cleared in three, improved in three, and were unchanged in two patients after antibiotic therapy.

Immunologic-mediated eustachian tube obstruction: a double-blind crossover study

Eight subjects with seasonal allergic rhinitis confirmed by positive skin tests and serum radioallergosorbent test to ragweed or timothy grass pollen were identified. A double-blind provocative antigen challenge was performed with intranasal insufflation of 50 mg of dry pollen to which the subject was either sensitive (ragweed or timothy) or not sensitive (pine). Before and after pollen insufflation, measurements of nasal function by nasal rhinomanometry and eustachian tube (ET) function by the nine-step tympanometry test were performed for up to 14 days. The ability to dilate the ET was documented in 14 of the 16 ears of the eight subjects before challenge. Within 30 min after antigen challenge transient obstruction of the ET associated with inability to dilate upon swallowing was observed in all 14 ears. Clinical symptoms of allergic rhinitis, including rhinorrhea and nasal obstruction, were produced in all subjects. ET function changes were reversible in three of 14 ears within 2 hr but persisted for more than 3 days in six of the ears. As a control, insufflation of pine pollen did not alter ET function or rhinomanometric values or produce clinical symptoms in the eight subjects. These findings suggest an allergic basis for ET obstruction and possibly for the development of otitis media with effusion.

912 A MONKEY MODEL FOR IgE MEDIATED OTITIS MEDIA WITH EFFUSION

An allergic (IgE) pathogenesis for otitis media with effusion (OME) has been suggested but not confirmed. Monkeys have been used previously to study allergic reactions by passive sensitization with serum from allergic patients. A method of insufflation of the eustachian tube (politzerization) by ragweed pollen grains was confirmed by recovery of pollen from the middle ear. Three normal juvenile monkeys were passively sensitized I.V. with human sera (high RAST anti-ragweed IgE titer), 40 cc/kg over 2 to 3 days and demonstrated positive skin tests and serum IgE antibodies to ragweed. Antigen challenge by politzerization with 0.1 gm ragweed pollen for 3 to 5 days induced OME as measured by tympanometry and confirmed by tympanocentesis in all animals. Similar studies in infant monkeys induced middle ear effusion (MEE) in 2 of 3 antigen challenges. In a single study without tympanocentesis, the OME resolved spontaneously in 5 days. A monkey given non-allérgic serum did not develop OME after ragweed antigen challenge via politzerization as described above. Another juvenile monkey passively sensitized with allergic serum was challenged by nasopharyngeal insufflation without eustachian tube entry of the ragweed pollen and no OME developed. Studies thus far of the MEE obtained by tympanocentesis have shown no bacterial organisms by gram stain or culture. A monkey model of IgE mediated MEE has been developed to study the pathogenesis and therapy of OME.