The impact of atopy on neutrophil activity in middle ear effusion from children and adults with chronic otitis media

Objective: To identify the relationship of neutrophil activity to allergy as reflected by the level of myeloperoxidase (MPO) in ears of atopic patients with chronic otitis media with effusion (OME) by objective testing. Design: Evidence of neutrophils was measured in the effusion of atopic patients with chronic OME. Atopy was determined by intradermal and/or in vitro testing of allergic reaction to 10 inhalants, 2 molds, and 5 foods. Subjects: Effusion MPO was measured prospectively in 138 ears from 106 consecutive patients with chronic OME, Results: A total of 86 (81%) of 106 patients with OME tested atopic by in vitro or in vivo testing. Excluding 36 ears with purulence, the mean MPO level was 3132 mug/L in 84 atopic vs 142 mug/L in 18 nonatopic ears (P<.001). A total of 78 (90%) of 87 patients with OME were atopic. Conclusions: The surprising finding of marked elevation of effusion MPO in atopic patients but very low levels in nonatopic patients (P<.001) suggests that atopy may contribute to elevated levels of neutrophil activity in OME. An atopic patient may respond differently from a nonatopic one to the microbial or viral products of acute inflammation owing to the presence of primed inflammatory cells. This study provides confirmation on a cellular level that neutrophils are an integral part of the inflammatory process in OME to a disproportionate degree among atopic patients.