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 Nicola Quaranta *, Claudia Milella, Lucia Iannuzzi, Matteo Gelardi Section of Otolaryngology, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari, Italy 1. Introduction Adenoid hyperthrophy (AH) is a frequent cause of upper airways obstruction in children [1]. AH has a typical onset after the third year of life with symptoms progressively worsening with a peak age incidence between 4 and 8 years. This clinical condition apart from typical nasal symptoms, voice and swallowing disorders, poor sleep quality, and occasionally facial dysmorph- isms and dental malocclusion, frequently lead to otitis media with effusion (OME) [2,3]. OME is defined as an inflammation of the middle ear accompanied by fluid collection in the middle ear cleft without signs and symptoms of acute infection [4]. The etiology of OME is debated and a large number of theories have been proposed to explain a condition that is probably multifactorial. Nasal allergy and AH have received support from some authors [5,6] although this view is not widely upheld [7]. AH may contribute to the development of OME mainly in two ways: a physical obstruction due to increased adenoid mass causing Eustachian tube dysfunc- tion or a local inflammatory reaction in the Eustachian tube and middle ear caused by release of inflammatory mediators [8]. However, although the nose, nasopharynx, Eustachian tube and middle ear are in an anatomical and functional continuity, not all the children affected by AH develop OME. In the recent years the advent of nasal cytology has allowed a more complete and precise classification of rhinitis [9]. Nasal cytology is a diagnostic tool currently used in rhinology, with the aim of assessing cell changes in the nasal epithelium exposed to irritant or inflammatory agents. Its rationale is based on the knowledge that nasal mucosa of healthy individuals is constituted by four cytotypes (ciliary cells, muciparous cells, striate cells, basal cells) and does not show other cells except, rarely, neutrophils and, very rarely, bacteria. In this view, the detection of cells type different from these is a sign of possible pathology [10]. According to the results of citology, skin prick test (SPT) and the period of nasal sampling it is possible to precisely diagnose infective rhinitis (IR), allergic rhinitis (AR) or different types of cellular non-allergic rhinitis (NAR). IR is characterized by abundant bacteria that may be found in extracellular tissue and also inside International Journal of Pediatric Otorhinolaryngology 77 (2013) 1980–1983 ARTICLE INFO Article history: Received 27 May 2013 Received in revised form 11 September 2013 Accepted 15 September 2013 Available online 23 September 2013 Keywords: Otitis media with effusion Adenoid hypertrophy Rhinitis Allergy Nasal cytology ABSTRACT Objective: The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy. Methods: 81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation. Results: Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02). Conclusions: A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME. ß 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Otolaryngology, University of Bari, Piazza G. Cesare n8 11, 70124 Bari, Italy. Tel.: +39 080 5478849; fax: +39 080 5478752. E-mail addresses: nicolaantonioadolfo.quaranta@uniba.it (N. Quaranta), claudiamilella@hotmail.it (C. Milella), aliceiannuzzi@hotmail.com (L. Iannuzzi), gelardim@inwind.it (M. Gelardi). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2013.09.017