The role of acute hypersensitivity in secretory otitis media

A review of 200 unselected patients with secretory otitis media suggests that allergy is present in about one fourth of the patients. If, however, a selected group of patients in whom multiple tubings have been performed is reviewed, the incidence of allergy is about one out of three. It is emphasized that the relationship between allergy and middle ear effusion can only be regarded as significant if the middle ear effusion is studied immunologically. Immunohistologic and immunochemical studies do not suggest that the middle ear mucosa is an allergic organ or that specific IgE antibody is produced locally in the middle ear in most instances. In only one P K test was there a suggestion that local production of IgE antibody could occur, thus fulfilling the concept of immediate hypersensitivity; that is, that passively allergized tissue cells release vasoactive substances when contacted by specific allergen. It is suggested that secretory otitis media is not an allergic disease per se, but that in about one third of the patients with chronic recurrent middle ear effusions edema of the eustachian tube and nasopharynx secondary to allergic disease occurs. This results in eustachian tube dysfunction and the production of middle ear disease.