Objective: We classified eosinophilic otitis media (EOM) into three grades (G1-G3) based on the middle ear mucosal thickness and aimed to establish a treatment strategy for EOM based on these pathological categories.
Study design: Retrospective cohort study.
Setting: Tertiary referral center.
Patients: We evaluated 136 ears of 68 patients (38 women, 30 men; average age, 56.1 yr; range, 32-80 yr) with bilateral EOM, including 14 surgically treated ears.
Interventions: Diagnostics and treatment.
Main outcome measures: Treatment responses to intratympanic instillation of triamcinolone acetonide (TA) and surgery.
Results: G1 (mild) cases of EOM responded well to intratympanic TA. G2 (moderate) cases required both TA and systemic glucocorticoids. G3 (severe) cases with granulation were unresponsive to but tolerated the treatment. In 14 ears, granulation tissue was surgically removed and the area was covered with a gelatin sponge containing TA. After the surgery, the severity level of EOM decreased from G3 to G2 in 12 ears, and hearing improved in 4 ears. Three ears showed normalization of the tympanic membrane, and seven ears had less otorrhea. Risk factors for granulation (G3) were the presence of bacterial infection (p = 0.017) and diabetes mellitus (HbA1c of ≥6.5%) (P = 0.039) (odds ratios of 4.55 and 3.95, respectively).
Conclusions: This study showed that G3 EOM was unresponsive to conservative glucocorticoid treatment and required granulation tissue removal. Classification based on the middle ear pathology is useful for determining the most appropriate and successful treatment for EOM.