Multisystem pathology in refractory otitis media with effusion
Reviewed by Madhup K Chaurasia

Recurrent middle ear effusion is a common problem and so is rhinosinusitis with polyposis. It is not often thought that the problem could be linked to multisystem pathology, such as eosinophilic granulomatous with polyposis. Therefore, repeated grommet insertions and surgical management of polyps produce little benefit. The object of this retrospective observational study was to explore the link between nasal polyposis and refractory otitis media with eosinophilic granulomatosis and polyangitis. Sixteen cases from two centres were identified of which 87.5% had asthma, 56.25% had serological eosinophilia and 43.75% had extravascular eosinophilia. This multisystem clinical problem seems to be pivoted on eosinophilic granulomatosis which goes through three phases: a prodromal phase, eosinophilic phase and vascular phase, the last being most serious. The authors emphasise that early recognition and a prompt referral to a vasculitis service will provide remission when treated with systemic glucocorticoid therapy to which the otologic manifestations are highly sensitive. This will also circumvent the use of stronger immunosuppressants such as cyclophosphamide. This article does evoke further thoughts on very commonly seen conditions such as nasal polyposis and recurrent middle ear effusions. 

Polyps, grommets and eosinophilic granulomatosis with polyangitis.
Kavanagh FG, Hasan W, Smyth DA, Fenton JE.
THE JOURNAL OF LARYNGOLOGY AND OTOLOPGY
2018;132:236-9.