Adenoid histamine and its possible relationship to secretory otitis media

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Abstract
Whether or not adenoids play a role in the pathogenesis of secretory otitis media (SOM) remains controversial (McKee et al., 1963; Dawes, 1970; Bluestone et al., 1975; Ruokonen, 1979; Elverland et al., 1981; Smyth, 1982). The belief that adenoidectomy is an important part of the treatment of the condition suggests that this may be so (Ransome, 1973). Many otolaryngologists (Hubbert, 1977) believe that the enlarged pad of adenoids may present a physical obstruction to the nasopharyngeal opening of the Eustachian tube, thus leading to the development of Eustachian tube dysfunction and subsequently to SOM. Bluestone (1971) has presented evidence of Eustachian tube obstruction by adenoid tissue; however, Sade (1979) believes that this is rarely the case in SOM. Besides presenting a possible physical obstruction, adenoids contain large amounts of mast cells capable of binding immunoglobulin E (IgE) and releasing histamine, together with other inflammatory mediators on antigen challenge (Church et al. 1981). They are thus in a unique position to initiate and maintain local allergic or inflammatory reactions, which may lead to Eustachian tube dysfunction. In this study we have defined the signs and symptoms of children admitted to Southampton General Hospital for the surgical treatment of SOM. We have also attempted to derive from their histories any allergic or environmental factors which may have given rise to their complaint. Following adenoidectomy, we have measured adenoid weight and histamine content and measured the histamine content of nasopharyngeal secretions and middle-ear fluid where present.