Skip to main content

Polyps, grommets and eosinophilic granulomatosis with polyangiitis

  • F G Kavanagh (a1), W Hasan (a1), D A Smyth (a2) and J E Fenton (a1) (a3)

To explore the link between nasal polyposis, refractory otitis media with effusion and eosinophilic granulomatosis with polyangiitis.


A retrospective observational study was carried out of patients diagnosed with refractory otitis media with effusion necessitating grommet insertion and who had nasal polyps. Patients were evaluated to determine if they fulfilled the diagnostic criteria of eosinophilic granulomatosis with polyangiitis.


Sixteen patients (10 males and 6 females) were identified. The mean age of grommet insertion was 45.4 years. The mean number of grommets inserted per patient was 1.6. The mean number of nasal polypectomies was 1.7. All 16 patients had paranasal sinus abnormalities and otitis media with effusion, 14 had asthma, 9 had serological eosinophilia and 7 had extravascular eosinophilia. Nine patients met the diagnostic criteria for eosinophilic granulomatosis with polyangiitis.


The co-presence of nasal polyps and resistant otitis media with effusion should raise the possibility of eosinophilic granulomatosis with polyangiitis.

Corresponding author
Address for correspondence: Dr Fergal Kavanagh, Department of Otolaryngology, Head and Neck Surgery, University Hospital, Newcastle Road, Galway, Ireland E-mail:
Hide All

Presented orally at the 57th Irish Otorhinolaryngology/Head and Neck Surgery Society Annual Meeting, 14 October 2016, Lough Eske, Ireland, and at the 25th Congress of the European Rhinologic Society, 22–26 June 2014, Amsterdam, The Netherlands.

Hide All
1 Churg, J, Strauss, L. Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol 1951;27:277301
2 Taki, H, Shinoda, K, Hounoki, H, Ogawa, R, Ishizawa, S, Sugiyama, E et al. Serum interleukin-5 levels correlate with disease activity of Churg-Strauss syndrome in a patient treated with a leucotriene receptor antagonist, pranlukast, and inhaled corticosteroid. Scand J Rheumatol 2010;39:341–3
3 Sinico, RA, Di Toma, L, Maggiore, U, Bottero, P, Radice, A, Tosoni, C et al. Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome. Arthritis Rheum 2005;52:2926–35
4 Guillevin, L, Cohen, P, Gayraud, M, Lhote, F, Jarrousse, B, Casassus, P. Churg-Strauss syndrome: clinical study and long-term follow-up of 96 patients. Medicine (Baltimore) 1999;78:2637
5 Olsen, KD, Neel, HB 3rd, DeRemee, RA, Weiland, LH. Nasal manifestations of allergic granulomatosis and angiitis (Churg-Strauss syndrome). Otolaryngol Head Neck Surg 1980;88:85–9
6 Martinez Del Pero, M, Moffat, D, Sudhoff, H. Unusual presentation of temporal bone involvement in Churg-Strauss syndrome. J Laryngol Otol 2008;122:425–7
7 Ovadia, S, Dror, I, Zubkov, T, Tanay, A, Levy, D, Zandman-Goddard, G. Churg–Strauss syndrome: a rare presentation with otological and pericardial manifestations: case report and review of the literature. Clin Rheumatol 2009;28(suppl 1):S358
8 Bacciu, A, Buzio, C, Giordano, D, Pasanisi, E, Vincenti, V, Mercante, G et al. Nasal polyposis in Churg-Strauss syndrome. Laryngoscope 2008;118:325–9
9 Comarmond, C, Pagnoux, C, Khellaf, M, Cordier, JF, Hamidou, M, Viallard, JF et al. ; French Vasculitis Study Group. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis Rheum 2013;65:270–81
10 Ribi, C, Cohen, P, Pagnoux, C, Mahr, A, Arène, JP, Lauque, D et al. ; French Vasculitis Study Group. Treatment of Churg-Strauss syndrome without poor-prognosis factors: a multicenter, prospective, randomized, open-label study of seventy-two patients. Arthritis Rheum 2008;58:586–94
11 Johansson, L, Akerlund, A, Holmberg, K, Melén, I, Bende, M. Prevalence of nasal polyps in adults: the Skövde population-based study. Ann Otol Rhinol Laryngol 2003;112:625–9
12 Scadding, GK, Durham, SR, Mirakian, R, Jones, NS, Drake-Lee, AB, Ryan, D et al. ; British Society for Allergy and Clinical Immunology. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008;38:260–75
13 Tewfik, TL, Mazer, B. The links between allergy and otitis media with effusion. Curr Opin Otolaryngol Head Neck Surg 2006;14:187–90
14 Parietti-Winkler, C, Baumann, C, Gallet, P, Gauchard, G, Jankowski, R. Otitis media with effusion as a marker of the inflammatory process associated to nasal polyposis. Rhinology 2009;47:396–9
15 Rosenfeld, RM, Culpepper, L, Doyle, KJ, Grundfast, KM, Hoberman, A, Kenna, MA et al. ; American Academy of Pediatrics Subcommittee on Otitis Media with Effusion; American Academy of Family Physicians; American Academy of Otolaryngology–Head and Neck Surgery. Clinical practice guideline: otitis media with effusion. Otolaryngol Head Neck Surg 2004;130(5 suppl):S95118
16 Nagamine, H, Iino, Y, Kojima, C, Miyazawa, T, Iida, T. Clinical characteristics of so called eosinophilic otitis media. Auris Nasus Larynx 2002;29:1928
17 Iino, Y, Tomioka-Matsutani, S, Matsubara, A, Nakagawa, T, Nonaka, M. Diagnostic criteria of eosinophilic otitis media, a newly recognized middle ear disease. Auris Nasus Larynx 2011;38:456–61
18 Gleich, GJ, Adolphson, CR. The eosinophilic leukocyte: structure and function. Adv Immunol 1986;39:177253
19 Gotlib, J. Molecular classification and pathogenesis of eosinophilic disorders: 2005 update. Acta Haematol 2005;114:725
20 Lanham, JG, Elkon, KB, Pusey, CD, Hughes, GR. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine (Baltimore) 1984;63:6581
21 Spry, CJ. Eosinophils: A Comprehensive Review, and Guide to the Scientific and Medical Literature. Oxford: Oxford University Press, 1988
22 Guillevin, L, Pagnoux, C, Seror, R, Mahr, A, Mouthon, L, Le Toumelin, P; French Vasculitis Study Group (FVSG). The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore) 2011;90:1927
23 Bourgarit, A, Le Toumelin, P, Pagnoux, C, Cohen, P, Mahr, A, Le Guern, V et al. ; French Vasculitis Study Group. Deaths occurring during the first year after treatment onset for polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: a retrospective analysis of causes and factors predictive of mortality based on 595 patients. Medicine (Baltimore) 2005;84:323–30
24 Ishiyama, A, Canalis, RF. Otological manifestations of Churg-Strauss syndrome. Laryngoscope 2001;111:1619–24
25 Keogh, KA, Specks, U. Churg-Strauss syndrome: clinical presentation, antineutrophil cytoplasmic antibodies, and leukotriene receptor antagonists. Am J Med 2003;115:284–90
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 52 *
Loading metrics...

Abstract views

Total abstract views: 345 *
Loading metrics...

* Views captured on Cambridge Core between 9th January 2018 - 15th August 2018. This data will be updated every 24 hours.