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Ear Disease Associated With Samter's Syndrome: Presented at AAO-HNS

By Jackie Beals

WASHINGTON, DC -- September 21, 2007 -- Researchers in Switzerland have found evidence of an association between otological disease and Samter's syndrome, an inflammatory condition characterised by the triad of bronchial asthma, nasal polyps, and intolerance to aspirin and aspirin-like medications.

A presentation here at the annual meeting of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation described the findings of a retrospective trial that evaluated clinical data from 1995 through 2005, and focused on the otological symptoms of Samter's syndrome patients.

Co-author Marco D. Caversaccio, MD, Professor, Department of Otorhinolaryngology, Head and Neck Surgery, and Institute of Anatomy, Berne University Hospital, Berne, Switzerland, was part of the team that reviewed 23 cases of patients (14 women), with an average age of 54, who had symptoms of Samter's syndrome. Nineteen of the 23 cases had a history of aspirin intolerance, and four demonstrated allergic symptoms during an inhalation provocation test with lysine-acetylsalicylic acid. In 17 cases, functional endoscopic sinus surgery (FESS) had been performed.

Six (26%) of the patients developed problems involving ear pressure and conductive hearing loss more than 5 years after the appearance of their initial nasal symptoms. Five of these patients required grommets (three unilateral, two bilateral), and one underwent a mastoidectomy.

The association of otological disease with "Samter's triad" thus constituted a "Samter's quartet" in 26% of the cases studied. Dr. Caversaccio emphasized the importance of recognizing this link, and suggested that the otological disease might also be treatable by systemic steroids, preventing progressive hearing loss and mastoiditis.

Additional tests in this study included otomicroscopy, nasal and pharyngeal endoscopy, audiometry, tympanometry, and computed tomography-endoscopy of the Eustachian tubes. Dr. Caversaccio reported that the results of the latter examination were surprising, as the tubes were not obstructed by polyps, but showed only secretions and inflammation.

Although they commonly occur together, the 3 defining characteristics of Samter's Triad are treated individually. Asthma is managed by avoiding the triggers and by medication when required. Polyps can be surgically removed or shrunk with corticosteroid treatment. Aspirin and related substances must be avoided. Many patients also show eosinophilia of the circulating blood, and Dr. Caversaccio noted that there are "a lot of eosinophils that you could find in the stromal structure."

Diagnosis can usually be made from history and physical examination, without resorting to an aspirin challenge test.


[Presentation title: Otologic Manifestations in Samter's Syndrome]

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