\s=b\Otitis media with effusion (OME) is a common middle ear inflammatory disease in the pediatric population. This article determines concentrations of three functionally and metabolically distinct inflammatory mediators in middle ear effusions (MEE) and corresponding plasma of children with OME. One hundred two patients (mean age, 4.9 years) with persistent OME were studied. Middle ear effusions were collected from all subjects and plasma from a subset at the time of tympanostomy tube insertion. Histamine was assayed radioisotopically, 13, 14-dihydro-15-keto-prostaglandin F2\g=a\(stable PGF2\g=a\ metabolite) by radioimmunoassay, and neutrophil chemotactic factor of anaphylaxis by modified Boyden chamber. Mean MEE levels of the mediators (39 \m=+-\ 13 ng/mL, 462 \m=+-\179 pg/mL, and 264% \ m=+-\ 57% positive control, respectively) were markedly higher than those of corresponding plasma (0.5 \m=+-\ 0.1 ng/mL, 285 \m=+-\127 pg/mL, and 47% \m=+-\5% positive control, respectively). The mean histamine content of mucoid effusions (43.2 \ m=+-\56.9 ng/mL) was significantly higher than that of purulent (22.5 \m=+-\10.5 ng/mL) and serous (17.9 \m=+-\ 16.8 ng/mL) effusions. Higher histamine levels were observed in effusions positive for Haemophilus influenzae when compared with those with other pathogenic isolates. The high concentrations of these mediators in MEE and their potential for inducing or sustaining the inflammatory process supports a role in the pathogenesis of OME. (Arch Otolaryngol Head Neck Surg 1988;114:1131-1133 Otitis media with effusion (OME) is a middle ear inflammatory dis¬ ease that is common in the pediatrie population. A variety of potent inflammatory mediators has been detected in middle ear effusions (MEE) of children with OME.1 More¬ over, a role for these mediators in the pathogenesis and maintenance of the disease condition was emphasized by the results of a number of recent experimental studies using animal models.2 In humans, IgE-dependent mediator release or allergy has also been incriminated as a risk factor in OME. This investigation determined MEE concentrations of two mast cellderived mediators, histamine and neutrophil chemotactic factor of anaphylaxis (NCF-A), and a stable metabolite of prostaglandin (PG)F2o. The latter two have not been previous¬ ly studied in OME. PATIENTS AND METHODSOne hundred two patients, aged 1 to 23 years (mean age, 4.9 years) with docu¬ mented persistent OME unresponsive to antimicrobial therapy were enrolled after obtaining informed consent. All patients had tympanostomy tubes inserted at which time MEEs were collected. Unilateral effu¬ sions were collected from 25 patients and bilateral effusions were collected from the remaining 17 patients. These samples were classified visually as serous, mucoid, or purulent; cultured immediately for aerobic bacteria; and a subset was submitted for complete cell count by Coulter Counter and differential. The remaining fluid (50 to 200
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