Bacterial involvement in otitis media with effusion

Kim

Clin Exp Otorhinolaryngol

et al. 2013

ObjectivesToll-like receptor (TLR)-9 recognizes unmethylated cytidine-phosphate-guanosine (CpG) motifs in bacteria. Therefore, the expression of TLR-9 may differ according to the results of bacterial culture, and thus a change in proinflammatory cytokine induction can also be expected. The authors aimed to assess the differences and relationships between the expression of TLR-9, cytokines, and nitric oxide synthase (NOS) in otitis media with effusion (OME) based on bacterial culture results.MethodsSixty-eight patients with OME were divided into culture-positive and culture-negative groups based on middle ear culture results. mRNA expression of TLR-9, NOS, and cytokines was measured and analyzed.ResultsBacteria were detected in 38.2% of patients, and the distribution was as follows: coagulase negative Staphylococcus (10.3%), Staphylococcus aureus (8.8%), Streptococcus pneumonia (5.9%), and Bacillus spp. and Haemophilus influenza combined (2.9%). There were no significant differences in epidemiologic characteristics according to the culture results. Down-regulation of TLR-9 was observed in the culture-positive group (P=0.019). Cytokines including interleukin (IL)-12 (r=-0.582), tumor necrosis factor (TNF)-α (r=-0.569), interferon (IFN)-γ (r=-0.442), IL-6 (r=-0.395) and inducible NOS (r=-0.256) tended to decrease with the detection of bacteria.ConclusionThe expression of TLR-9 significantly decreased in OME with confirmed bacterial pathogens. IL-12, TNF-α, IFN-β, IL-6 expression tended to decrease with the detection of bacteria. The presence of bacterial pathogens in OME may be related to abnormalities in the innate immune system.

Section: Discussionmentioning

confidence: 99%

“…Interestingly, recent studies have shown that CNS is more prevalent in MEEF than are the three traditional pathogens. This may be because of variation in bacterial prevalence over time, antibiotic use, and/or vaccination against H. influenzae and S. pneumoniae [12,14]. …”

Section: Discussionmentioning

confidence: 99%

Decreased Expression of TLR-9 and Cytokines in the Presence of Bacteria in Patients with Otitis Media with Effusion

Kim

Clin Exp Otorhinolaryngol

et al. 2013

“…An underlying stimulus leads to an inflammatory reaction33 with production of more mucin and altered, more viscous mucin types,11 which then overwhelms normal mucociliary clearance of the middle ear with functional blockage of the eustachian tube, resulting in the accumulation of a thick, mucin-rich middle ear effusion 26. Over the last few years it has become recognized that bacterial biofilms are important in the etiology of OME 34,35. These three-dimensional communities of bacteria, attached to a surface, encased in self-produced extracellular matrix, and with altered phenotype, are thought to exert a chronic inflammatory stimulus leading to OME.…”

Section: Etiologymentioning

confidence: 99%

Update on otitis media – prevention and treatment

Qureishi¹,

Lu²,

Belfield³

et al. 2014

IDR

105

Acute otitis media and otitis media with effusion are common childhood disorders, a source of significant morbidity, and a leading cause of antibiotic prescription in primary health care. Although effective treatments are available, some shortcomings remain, and thus better treatments would be welcome. Recent discoveries within the field of otitis media research relating to its etiology and pathogenesis have led to further investigation aimed at developing novel treatments. This article provides a review of the latest evidence relating to the understanding of acute otitis media and otitis media with effusion, current treatment strategies, their limitations, new areas of research, and novel strategies for treatment.

“…Otitis media with effusion (OME) is a multifactorial disease with infection, possibly biofilm in nature (3,4) and Eustachian tube dysfunction (5) are the most widely accepted etiologies. Many risk factors have been associated with this disease: young age (6,7) lack of breast feeding (6,8,9) low mother education, (9)(10)(11) low socioeconomic status (6,10) day care attendance (8,11) parental smoking, (6,11,12) upper respiratory tract infections (6,9,11) allergy (6,9,11,13,14) and snoring.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors of Otitis Media with Effusion in School Children in Qassim Region of Saudi Arabia

Alhumaid¹,

Abou-Halawa²

2014

IJHS

Abstract:Objective: To determine the prevalence of otitis media with effusion (OME) among school children in Qassim region of Kingdom of Saudi Arabia and to determine relevant risk factors in affected children. Methods:Through a cross-sectional study, 1488 children in the age range 6-12 years were randomly selected from 25 primary schools in Qassim region. A questionnaire was used to determine risk factors for OME. Otoscopy and tympanometry were used to diagnose and confirm OME. Pure tone average for children with confirmed OME was measured. Teachers of children were asked to complete a questionnaire evaluating child's level of school performance. Results:Prevalence of OME in the study population was 7.5% (112/1488). In univariate analysis, it was strongly associated with age less than 8 years (p< 0.0001; OR= 4.23, 95% CI: 2.85-6.29 ), family size more than 4 members in the household((p<0.0001; OR= 4.45, 95% CI: 2.23-8.88), mother education less than secondary school education (p<0.0001; OR=2.2, 95% CI: 1.47-3.29), recurrent acute otitis media (AOM) (p<0.0001; OR=5.73, 95% CI: 3.47-9.45), and hearing loss symptom (p< 0.0001; OR= 3.39, 95% CI: 1.92-5.99). It is less strongly associated with history of preschool AOM (p= 0.002; OR= 3.15, 95% CI: 1.67-5.97), nasal discharge (p= 0.003; OR= 1.91, 95% CI: 1.24-2.93) and snoring (p=0.03; OR= 1.76, 95% CI: 1.06-2.94). OME was significantly higher in schools located in rural districts (p<0.001, OR= 2.82, 95% CI: 1.86 -4.28). In multivariate regression model, five of these factors were found to be predictors of OME: age less than 8 years (OR= 5.052, 95% CI:3.289-7.762), family size more than4 members in the household) (OR= 4.192, 95% CI: 2.033-8.643), rural school district (OR=3.037, 95% CI: 1.933-4.772), mother education lower than secondary school education) (OR=2.041, 95% CI:1.602-3.877) and recurrent AOM (OR=4.914, 95% CI: 2.677-9.02). Children with OME tend to have poorer school performance compared to normal children (p=0.067). No significant correlation was found between OME and type of feeding during the first two years of life (p=0.62; OR= 0.87, 95% CI: 0.51-1.49), preschool daycare attendance (p=0.17; OR= 0.71, 95% CI: 0.44-1.16), home exposure to cigarette smoke (p=0.4; OR= 1.34, 95% CI:0.68 -2.65), visits to ENT clinic (p=0.13; OR= 0.58, 95% CI:0.29-1.18), and ENT operations (p=0.12; OR= 0.46, 95% CI: 0.17-1.27). Conclusion:Prevalence of OME in Qassim region reaches 7.5% in school children. Age less than 8 years, family size more than 4 members in the household, mother education less than secondary school education, living in rural area and recurrent AOM are found to be predictors of OME in Qassim region. In this population of children, otoscopy and tympanometry should be used as screening tools for OME.