Advertisement

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

  • Rachel E. Roditi
  • David S. Caradonna
  • Jennifer J. ShinEmail author
Otitis (DP Skoner, Section Editor)
  • 52 Downloads
Part of the following topical collections:
  1. Topical Collection on Otitis

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.

Keywords

Otitis media with effusion Eustachian tube dysfunction Allergic rhinitis Antihistamines Intranasal steroids Adenoid 

Notes

Compliance with Ethical Standards

Conflict of Interest

RER is a consultant for Roche Genentech, Gossamer Bio, and Syneos Health. DSC has no disclosures. JJS receives textbook royalties from Evidence-Based Otolaryngology, Shin JJ, Randolph GW, editors; New York: Springer, 2008, and from Otolaryngology Prep and Practice. Shin JJ, Cunningham MJ, editors; Plural Publishing, 2013. JJS is also a recipient of the American Academy of the Otolaryngology-Head and Neck Surgery Foundation Maureen Hannley grant, the Brigham Care Redesign Program Award, and the Schlager Family Innovations Fund Award.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Allergies | Gateway to Health Communication | CDC. https://www.cdc.gov/healthcommunication/ToolsTemplates/EntertainmentEd/Tips/Allergies.html. Accessed 30 Jul 2018.
  2. 2.
    Blaiss MS. Allergic rhinitis: direct and indirect costs. Allergy Asthma Proc. 2010;31:375–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Meltzer EO, Bukstein DA. The economic impact of allergic rhinitis and current guidelines for treatment. Ann Allergy Asthma Immunol. 2011;106:S12–6.CrossRefPubMedGoogle Scholar
  4. 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. CrossRefGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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. Google Scholar
  7. 7.
    Goodrich T, Rubio F, Cutler JL. Otitis media and antihistamines. Curr Allergy Asthma Rep. 2009;9:456–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Rosenfeld RM, Shin JJ. Clinical Practice Guideline. Head Neck Surg 14.Google Scholar
  9. 9.
    Tos M. Epidemiology and natural history of secretory otitis. Am J Otol. 1984;5:459–62.PubMedGoogle Scholar
  10. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.Google Scholar
  13. 13.
    Griffin G, Flynn CA. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2011.  https://doi.org/10.1002/14651858.CD003423.pub3.
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 16.
    Lewis ER. Otitis media and allergy. Ann Otol Rhin Laryng. 1929;38.Google Scholar
  17. 17.
    Krouse JH. The unified airway—conceptual framework. Otolaryngol Clin N Am. 2008;41:257–66.CrossRefGoogle Scholar
  18. 18.
    Handelman CS, Osborne G. Growth of the nasopharynx and adenoid development from one to eighteen years. Angle Orthodontist. 1976;46:243–59.PubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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.Google Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 33.
    Zitt M, Kosoglou T, Hubbell J. Mometasone furoate nasal spray: a review of safety and systemic effects. Drug Saf. 2007;30:317–26.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 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.CrossRefPubMedGoogle Scholar
  38. 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.Google Scholar
  39. 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. CrossRefGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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.Google Scholar
  42. 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.Google Scholar
  43. 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.CrossRefPubMedGoogle Scholar
  44. 44.
    Williamson I. Otitis media with effusion in children. BMJ Clin Evid. 2011;2011.Google Scholar
  45. 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.CrossRefPubMedGoogle Scholar
  46. 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.CrossRefPubMedGoogle Scholar
  47. 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.Google Scholar
  48. 48.
    Newman SP, Morén F, Clarke SW. Deposition pattern from a nasal pump spray. Rhinology. 1987;25:77–82.PubMedGoogle Scholar
  49. 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.CrossRefPubMedGoogle Scholar
  50. 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.CrossRefPubMedGoogle Scholar
  51. 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.CrossRefPubMedGoogle Scholar
  52. 52.
    Cutler JL, Labadie RF. Effects of ototopical antihistamine on otitis media in an allergic rat. Laryngoscope. 2008;118:283–7.CrossRefPubMedGoogle Scholar
  53. 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.CrossRefPubMedGoogle Scholar
  54. 54.
    Coleman C, Moore M. Decongestants and antihistamines for acute otitis media in children. Cochrane Database Syst Rev. 2008:CD001727.Google Scholar
  55. 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.CrossRefPubMedGoogle Scholar
  56. 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.CrossRefPubMedGoogle Scholar
  57. 57.
    Griffin G, Flynn CA, Bailey RE, Schultz JK. Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Cochrane Database Syst Rev. 2006.  https://doi.org/10.1002/14651858.CD003423.pub2.
  58. 58.
    Mb AGB, Frcpc RDG Antihistamines for children with otitis media. 3.Google Scholar
  59. 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.CrossRefPubMedGoogle Scholar
  60. 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.PubMedGoogle Scholar
  61. 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. CrossRefGoogle Scholar
  62. 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.CrossRefPubMedGoogle Scholar
  63. 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. CrossRefPubMedGoogle Scholar
  64. 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. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rachel E. Roditi
    • 1
  • David S. Caradonna
    • 2
  • Jennifer J. Shin
    • 1
    Email author
  1. 1.Department of Otolaryngology-Head and Neck SurgeryHarvard Medical School, Brigham & Women’s HospitalBostonUSA
  2. 2.Department of Otolaryngology-Head and Neck SurgeryHarvard Medical School, Beth Israel Deaconess Medical CenterBostonUSA

Personalised recommendations