OTIC AND NASAL POLYPS WITH PERIPHERAL EOSINOPHILIA AND BILATERAL HEARING LOSS

Introduction Refractory otitis media (OM) in adults is challenging as misdiagnosis can lead to permanent sensorineural hearing loss. OM in the presence of peripheral eosinophilia and atopic history should warrant alternative treatment rather than antibiotics and topical steroids. Case Description A 71-year-old female with asthma, nasal polyps and allergic rhinitis presented with two years of bilateral hearing loss. She had multiple episodes of recurrent otitis media treated with topical and systemic steroids along with antibiotics without improvement. Physical exam was significant for hypertrophied turbinates and anterior rhinoscopy showed a large polyp in the right middle meatus. Otoendoscopy showed a right tympanic membrane with chronic myringitis, central perforation with polypoid changes to the middle ear mucosa. Left tympanic membrane had central perforation and polypoid tissue (Figure 1). Labs were significant for peripheral eosinophilia of 1.3 × 10 3 eosinophils/μL (16.7%) and IgE level of 1065 IU/mL. A diagnosis of presumed eosinophilic otitis media was made. Discussion Eosinophilic otitis media (EOM) is a rare disorder of intractable bilateral otitis media. Diagnosis can be made using the major criteria of eosinophils in the middle ear mucosa or its effusion, along with two or more items of the minor criteria (association with asthma, nasal polyposis, chronic rhinosinusitis, resistance to conventional treatment for otitis media, and a highly viscous middle ear effusion). The differential should exclude disorders such as eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome. Treatment of EOM includes removal of eosinophilic middle ear effusion and suppression with steroids.