Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Die Folgen des Klimwandels haben einen direkten Einfluss auf die Primärversorgung in Deutschland: Hitzeschutz insbesondere bei älteren Patienten, die Zunahme von Infektionen und die Verlängerung der Allergiesesaison spielen medizinisch eine bedeutsame Rolle. Aber auch in der Prävention und der Aufklärung der Patienten kommt den Hausärztinnen und -ärzten eine besondere Rolle zu. Direkt aus der Praxis berichtet im Live-Webinar am 13. Mai von 18 bis 19 Uhr unser Experte Dr. med. Robin Maitra.
Erweiterte Suche
Anmelden
nach oben
Current Allergy and Asthma Reports
Erschienen in: Current Allergy and Asthma Reports 10/2019

01.10.2019 | Otitis (DP Skoner, Section Editor)

The Proposed Usage of Intranasal Steroids and Antihistamines for Otitis Media with Effusion

verfasst von: Rachel E. Roditi, David S. Caradonna, Jennifer J. Shin

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

To examine the role of allergy medications in the treatment of otitis media with effusion (OME), focusing on use of intranasal steroids and antihistamines.

Recent Findings

There has been ongoing controversy regarding the role of allergy in the development of OME. Treatment of OME with medications commonly used for allergic symptomatology has been studied. Proposed treatment options include decongestants, mucolytics, oral steroids, topical steroids, antihistamines, and antibiotics. We begin by evaluating the proposed association between allergy and OME, and then evaluate intranasal steroids and oral antihistamine therapy in the treatment of OME. The role of the adenoid and concurrent nasal symptomatology is also addressed.

Summary

The preponderance of data suggests that neither intranasal steroids nor antihistamines improve the long-term clearance of isolated OME and are therefore not recommended. However, data are notably limited with regard to improvement rates in OME in patients specifically with concurrent allergy and/or adenoid hypertrophy. Future studies of medications for OME would ideally incorporate study designs controlling for both allergic rhinitis and adenoid hypertrophy, to better understand the impact of these medications on OME in these subgroups of patients.
Literatur
1.
2.
Blaiss MS. Allergic rhinitis: direct and indirect costs. Allergy Asthma Proc. 2010;31:375–80.CrossRefPubMed
3.
Meltzer EO, Bukstein DA. The economic impact of allergic rhinitis and current guidelines for treatment. Ann Allergy Asthma Immunol. 2011;106:S12–6.CrossRefPubMed
4.
•• Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngology–Head Neck Surg. 2016;154:S1–S41 COMMENT: excellent overview of most recent clinical practice guidelines for OME. CrossRef
5.
Vila PM, Thomas T, Liu C, Poe D, Shin JJ. The burden and epidemiology of Eustachian tube dysfunction in adults. Otolaryngol Head Neck Surg. 2017;156:278–84.CrossRefPubMed
6.
•• Wise SK, Lin SY, Toskala E, et al. International consensus statement on allergy and rhinology: allergic rhinitis: ICAR: allergic rhinitis. Int Forum of Allergy Rhinol. 2018;8:108–352 COMMENT: excellent overview of clinical practice guidelines for allergic rhinitis and its treatment.
7.
Goodrich T, Rubio F, Cutler JL. Otitis media and antihistamines. Curr Allergy Asthma Rep. 2009;9:456–9.CrossRefPubMed
8.
Rosenfeld RM, Shin JJ. Clinical Practice Guideline. Head Neck Surg 14.
9.
Tos M. Epidemiology and natural history of secretory otitis. Am J Otol. 1984;5:459–62.PubMed
10.
Marom T, Tan A, Wilkinson GS, Pierson KS, Freeman JL, Chonmaitree T. Trends in otitis media–related health care use in the United States, 2001-2011. JAMA Pediatr. 2014;168:68.CrossRefPubMedPubMedCentral
11.
Finkelstein Y, Ophir D, Talmi YP, Shabtai A, Strauss M, Zohar Y. Adult-onset otitis media with effusion. Arch Otolaryngol Head Neck Surg. 1994;120:517–27.CrossRefPubMed
12.
Simpson SA, Lewis R, van der Voort J, Butler CC. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. 2011:CD001935.
13.
14.
Bousquet J, Annesi-Maesano I, Carat F, Léger D, Rugina M, Pribil C, et al. Characteristics of intermittent and persistent allergic rhinitis: DREAMS study group. Clin Exp Allergy. 2005;35:728–32.CrossRefPubMed
15.
Vandenplas O, Vinnikov D, Blanc PD, et al. Impact of rhinitis on work productivity: a systematic review. J Allergy Clin Immunol Pract. 2018;6:1274–1286.e9.CrossRefPubMed
16.
Lewis ER. Otitis media and allergy. Ann Otol Rhin Laryng. 1929;38.
17.
Krouse JH. The unified airway—conceptual framework. Otolaryngol Clin N Am. 2008;41:257–66.CrossRef
18.
Handelman CS, Osborne G. Growth of the nasopharynx and adenoid development from one to eighteen years. Angle Orthodontist. 1976;46:243–59.PubMed
19.
Rout MR, Mohanty D, Vijaylaxmi Y, Bobba K, Metta C. Adenoid hypertrophy in adults: a case series. Indian J Otolaryngol Head Neck Surg. 2013;65:269–74.CrossRefPubMed
20.
Yazici H, Soy FK, Kulduk E, Doğan S, Dündar R, Sakarya EU, et al. Comparison of nasal mucociliary clearance in adenoid hypertrophy with or without otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2014;78:1143–6.CrossRefPubMed
21.
Arnaoutakis D, Collins WO. Correlation of mucociliary clearance and symptomatology before and after adenoidectomy in children. Int J Pediatr Otorhinolaryngol. 2011;75:1318–21.CrossRefPubMed
22.
Quaranta N, Milella C, Iannuzzi L, Gelardi M. A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy. Int J Pediatr Otorhinolaryngol. 2013;77:1980–3.CrossRefPubMed
23.
Collins MP, Church MK, Bakhshi KN, Osborne J. Adenoid histamine and its possible relationship to secretory otitis media. J Laryngol Otol. 1985;99:685–91.CrossRefPubMed
24.
Ulualp SO, Sahin D, Yilmaz N, Anadol V, Peker O, Gursan O. Increased adenoid mast cells in patients with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 1999;49:107–14.CrossRefPubMed
25.
Yilmaz HB, Celebi S, Sahin-Yilmaz A, Oysu C. The role of mometasone furoate nasal spray in the treatment of adenoidal hypertrophy in the adolescents: a prospective, randomized, cross-over study. Eur Arch Otorhinolaryngol. 2013;270:2657–61.CrossRefPubMed
26.
Bhargava R, Chakravarti A. Role of mometasone furoate aqueous nasal spray for management of adenoidal hypertrophy in children. J Laryngol Otol. 2014;128:1060–6.CrossRefPubMed
27.
Bhargava R, Chakravarti A. A double-blind randomized placebo-controlled trial of topical intranasal mometasone furoate nasal spray in children of adenoidal hypertrophy with otitis media with effusion. Am J Otolaryngol. 2014;35:766–70.CrossRefPubMed
28.
Butler CC, Van Der Voort JH. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. 2002:CD001935.
29.
Simon F, Haggard M, Rosenfeld RM, Jia H, Peer S, Calmels M-N, et al. International consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135:S33–9.CrossRefPubMed
30.
Barnes PJ, Pedersen S. Efficacy and safety of inhaled corticosteroids in asthma. Report of a workshop held in Eze, France, October 1992. Am Rev Respir Dis. 1993;148:S1–26.CrossRefPubMed
31.
Howland WC, Hampel FC, Martin BG, Ratner PH, van Bavel JH, Field EA. The efficacy of fluticasone propionate aqueous nasal spray for allergic rhinitis and its relationship to topical effects. Clin Ther. 1996;18:1106–17.CrossRefPubMed
32.
Rudmik L, Hoy M, Schlosser RJ, Harvey RJ, Welch KC, Lund V, et al. Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3:281–98.CrossRefPubMed
33.
Zitt M, Kosoglou T, Hubbell J. Mometasone furoate nasal spray: a review of safety and systemic effects. Drug Saf. 2007;30:317–26.CrossRefPubMed
34.
Tracy JM, Demain JG, Hoffman KM, Goetz DW. Intranasal beclomethasone as an adjunct to treatment of chronic middle ear effusion. Ann Allergy Asthma Immunol. 1998;80:198–206.CrossRefPubMed
35.
Lack G, Caulfield H, Penagos M. The link between otitis media with effusion and allergy: a potential role for intranasal corticosteroids: OME and allergy. Pediatr Allergy Immunol. 2011;22:258–66.CrossRefPubMed
36.
El-Anwar M, Nofal A, Khazbak A, Sayed A, Hassan M. The efficacy of nasal steroids in treatment of otitis media with effusion: a comparative study. Int Arch Otorhinolaryngol. 2015;19:298–301.CrossRefPubMedPubMedCentral
37.
Cengel S, Akyol MU. The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy. Int J Pediatr Otorhinolaryngol. 2006;70:639–45.CrossRefPubMed
38.
Akyol MU, Cengel S (2006) The role of topical nasal steroid aerosol treatment in children with otitis media with effusion and/or adenoid hypertrophy. 12 months follow up.
39.
•• Cheng X, Sheng H, Ma R, et al. Allergic rhinitis and allergy are risk factors for otitis media with effusion: a meta-analysis. Allergol Immunopathol. 2017;45:25–32 COMMENT: meta-analysis reviewing the relationship between allergic rhinitis and OME. CrossRef
40.
Mikals SJ, Brigger MT. Adenoidectomy as an adjuvant to primary tympanostomy tube placement: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2014;140:95–101.CrossRefPubMed
41.
van den Aardweg MT, Schilder AG, Herkert E, Boonacker CW, Rovers MM. Adenoidectomy for otitis media in children. Cochrane Database Syst Rev. 2010:CD007810.
42.
van den Aardweg MT, Schilder AG, Herkert E, Boonacker CW, Rovers MM. Adenoidectomy for recurrent or chronic nasal symptoms in children. Cochrane Database Syst Rev. 2010:CD008282.
43.
Williamson I, Benge S, Barton S, Petrou S, Letley L, Fasey N, et al. A double-blind randomised placebo-controlled trial of topical intranasal corticosteroids in 4- to 11-year-old children with persistent bilateral otitis media with effusion in primary care. Health Technol Assess. 2009;13:1–144.CrossRefPubMed
44.
Williamson I. Otitis media with effusion in children. BMJ Clin Evid. 2011;2011.
45.
Petrou S, Dakin H, Abangma G, Benge S, Williamson I. Cost-utility analysis of topical intranasal steroids for otitis media with effusion based on evidence from the GNOME trial. Value Health. 2010;13:543–51.CrossRefPubMed
46.
Gluth MB, McDonald DR, Weaver AL, Bauch CD, Beatty CW, Orvidas LJ. Management of eustachian tube dysfunction with nasal steroid spray: a prospective, randomized, placebo-controlled trial. Arch Otolaryngol Head Neck Surg. 2011;137:449–55.CrossRefPubMed
47.
Berkman ND, Wallace IF, Steiner MJ, Harrison M, Greenblatt AM, Lohr KN, et al. Otitis media with effusion: comparative effectiveness of treatments. Rockville: Agency for Healthcare Research and Quality (US); 2013.
48.
Newman SP, Morén F, Clarke SW. Deposition pattern from a nasal pump spray. Rhinology. 1987;25:77–82.PubMed
49.
Thomas WW, Harvey RJ, Rudmik L, Hwang PH, Schlosser RJ. Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2013;3:691–703.CrossRefPubMed
50.
Kanowitz SJ, Batra PS, Citardi MJ. Topical budesonide via mucosal atomization device in refractory postoperative chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2008;139:131–6.CrossRefPubMed
51.
Djupesland PG, Skretting A, Winderen M, Holand T. Breath actuated device improves delivery to target sites beyond the nasal valve. Laryngoscope. 2006;116:466–72.CrossRefPubMed
52.
Cutler JL, Labadie RF. Effects of ototopical antihistamine on otitis media in an allergic rat. Laryngoscope. 2008;118:283–7.CrossRefPubMed
53.
Chonmaitree T, Saeed K, Uchida T, Heikkinen T, Baldwin CD, Freeman DH, et al. A randomized, placebo-controlled trial of the effect of antihistamine or corticosteroid treatment in acute otitis media. J Pediatr. 2003;143:377–85.CrossRefPubMed
54.
Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev. 2008:CD001727.
55.
Ting S, Rauls DO, Reiman BE. Inhibitory effect of hydroxyzine on antigen-induced histamine release in vivo. J Allergy Clin Immunol. 1985;75:63–6.CrossRefPubMed
56.
Suzuki M, Kerakawauchi H, Kawauchi H, Mogi G. Efficacy of an antiallergic drug on otitis media with effusion in association with allergic rhinitis. An experimental study. Ann Otol Rhinol Laryngol. 1999;108:554–8.CrossRefPubMed
57.
58.
Mb AGB, Frcpc RDG Antihistamines for children with otitis media. 3.
59.
Ertugay CK, Cingi C, Yaz A, San T, Ulusoy S, Erdogmus N, et al. Effect of combination of montelukast and levocetirizine on otitis media with effusion: a prospective, placebo-controlled trial. Acta Otolaryngol. 2013;133:1266–72.CrossRefPubMed
60.
Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP. Otitis media: diagnosis and treatment. Am Fam Physician. 2013;88:435–40.PubMed
61.
•• Wang DE, Lam DJ, Bellmunt AM, Rosenfeld RM, Ikeda AK, Shin JJ. Intranasal steroid use for otitis media with effusion: ongoing opportunities for quality improvement. Otolaryngology-Head Neck Surg. 2017;157:289–96 COMMENT: Study showing that despite randomized controlled trials showing lack of efficacy of intranasal steroids for treatment of OME, this treatment strategy is still commonly used in the US. CrossRef
62.
Prince AA, Rosenfeld RM, Shin JJ. Antihistamine use for otitis media with effusion: ongoing opportunities for quality improvement. Otolaryngol Head Neck Surg. 2015;153:935–42.CrossRefPubMed
63.
•• Roditi RE, Rosenfeld RM, Shin JJ. Otitis media with effusion: our national practice. Otolaryngol Head Neck Surg. 2017;157:171–2 COMMENT: Overview of adherence to guidelines for treatment of OME identifying current practice patterns and opportunities for improvement. CrossRefPubMed
64.
•• McCoul ED, Weinreich HM, Mulder H, Man L-X, Schulz K, Shin JJ. Health care utilization and prescribing patterns for adult Eustachian tube dysfunction. Otolaryngology–Head Neck Surg. 2019:019459981982695 COMMENT: Study evaluating practice patterns and epidemiologic data in the treatment of eustachian tube dysfunction in adults.
Metadaten
Titel
The Proposed Usage of Intranasal Steroids and Antihistamines for Otitis Media with Effusion
verfasst von
Rachel E. Roditi
David S. Caradonna
Jennifer J. Shin
Publikationsdatum
01.10.2019
Verlag
Springer US
Erschienen in
Current Allergy and Asthma Reports / Ausgabe 10/2019
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-019-0879-x

Weitere Artikel der Ausgabe 10/2019

Current Allergy and Asthma Reports 10/2019 Zur Ausgabe

Asthma (V Ortega, Section Editor)

The Effects of Obesity in Asthma

Otitis (DP Skoner, Section Editor)

Chronic Rhinosinusitis with Nasal Polyps in Older Adults: Clinical Presentation, Pathophysiology, and Comorbidity

Asthma (V Ortega, Section Editor)

Novel Insights on Sex-Related Differences in Asthma

Basic and Applied Science (I Lewkowich, Section Editor)

Bitter Taste Receptors: an Answer to Comprehensive Asthma Control?

Asthma (V Ortega, Section Editor)

Hot Topic: Precision Medicine for Asthma—Has the Time Come?

Neu im Fachgebiet HNO

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Nur selten Nachblutungen nach Abszesstonsillektomie

03.05.2024 Tonsillektomie Nachrichten

In einer Metaanalyse von 18 Studien war die Rate von Nachblutungen nach einer Abszesstonsillektomie mit weniger als 7% recht niedrig. Nur rund 2% der Behandelten mussten nachoperiert werden. Die Therapie scheint damit recht sicher zu sein.

Rezidivierender Peritonsillarabszess nach Oralsex

02.05.2024 Peritonsillarabszess Kasuistik

Die erotischen Dimensionen von Peritonsillarabszessen scheinen eng begrenzt zu sein. Das heißt aber nicht, solche Abszesse und Erotik hätten nichts miteinander gemein, wie ein Fallbericht verdeutlicht.

Update HNO

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen
Bildnachweise