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Advisor(s)
Abstract(s)
A otite média eosinofílica é uma entidade recentemente reconhecida, que se caracteriza pela acumulação de eosinófilos no ouvido médio e pela presença de derrame muito viscoso. Trata-se de uma doença crónica intratável frequentemente bilateral, que surge habitualmente em adultos com idade média de 50 anos, com antecedentes de asma brônquica e/ou pólipos nasais. A surdez pode surgir súbita ou gradualmente durante a progressão da doença, o que torna importante o diagnóstico adequado e precoce desta patologia. O mecanismo específico que leva à acumulação de eosinófilos ainda não é bem conhecido, mas considera-se que haja uma disfunção da trompa de Eustáquio que facilita a invasão/contaminação por agentes estranhos. Tal pode, em doentes com predisposição alérgica, contribuir para o desenvolvimento e/ou agravamento de inflamação crónica eosinofílica. A acumulação de eosinófilos é toxina para a mucosa do ouvido médio e o dano surge como resultado da activação de um processo de morte celular conhecido por ETosis. Várias citocinas e quimiocinas já foram identificadas como sendo participantes neste processo, mas é necessária mais investigação para compreender melhor a fisiopatologia desta doença.
Aquando do diagnóstico da otite média eosinofílica é fundamental excluir outras patologias como a poliangeíte granulomatosa eosinofílica. O tratamento desta doença baseia-se no uso de corticóides tópicos e, por vezes, sistémicos, bem como na optimização do tratamento da asma, nomeadamente com recurso a fármacos como o omalizumab. No futuro poderão surgir alternativas terapêuticas dirigidas ao mecanismo patológico desta doença.
Eosinophilic otitis media is a recently recognized disease characterized by the accumulation of eosinophils in the middle ear and by the presence of very viscous effusion. It is a chronic, often bilateral, intractable disease that usually occurs in adults with a mean age of 50 years with a history of bronchial asthma and / or nasal polyps. Deafness may appear suddenly or gradually during disease progression, which makes early and appropriate diagnosis of this condition important. The specific mechanism leading to the accumulation of eosinophils is not yet well known, but Eustachian tube dysfunction is thought to facilitate invasion / contamination by foreign agents. In patients with allergic predisposition this may lead to the development of chronic eosinophilic inflammation. Eosinophil accumulation is toxic to the middle ear mucosa and the damage arises because of the activation of a cell death process known as ETosis. Several cytokines and chemokines have been identified as being participants in this process, but more research is needed to better understand the pathophysiology of this disease. In the diagnosis of eosinophilic otitis media, it is essential to exclude other pathologies such as eosinophilic granulomatous polyangiitis. The treatment of this disease is based on topical and sometimes systemic corticosteroids and on optimizing of asthma treatment with the use of drugs such as omalizumab. In the future, novel target treatment may appear to address the pathological mechanism of this disease.
Eosinophilic otitis media is a recently recognized disease characterized by the accumulation of eosinophils in the middle ear and by the presence of very viscous effusion. It is a chronic, often bilateral, intractable disease that usually occurs in adults with a mean age of 50 years with a history of bronchial asthma and / or nasal polyps. Deafness may appear suddenly or gradually during disease progression, which makes early and appropriate diagnosis of this condition important. The specific mechanism leading to the accumulation of eosinophils is not yet well known, but Eustachian tube dysfunction is thought to facilitate invasion / contamination by foreign agents. In patients with allergic predisposition this may lead to the development of chronic eosinophilic inflammation. Eosinophil accumulation is toxic to the middle ear mucosa and the damage arises because of the activation of a cell death process known as ETosis. Several cytokines and chemokines have been identified as being participants in this process, but more research is needed to better understand the pathophysiology of this disease. In the diagnosis of eosinophilic otitis media, it is essential to exclude other pathologies such as eosinophilic granulomatous polyangiitis. The treatment of this disease is based on topical and sometimes systemic corticosteroids and on optimizing of asthma treatment with the use of drugs such as omalizumab. In the future, novel target treatment may appear to address the pathological mechanism of this disease.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Keywords
Otite média eosinofílica Asma brônquica Derrame ouvido médio Pólipos nasais Eosinófilos Otorrinolaringologia