Human rhinoviruses in otitis media with effusion

Abstract

Frequent viral upper respiratory tract infections (URTI) are considered to be risk factors for otitis media with effusion (OME). Atopy has also been associated with both OME and viral infections. The aim of this study was to evaluate the presence of viruses in middle ear effusions (MEE) in children 2-7 yr old with OME, and to determine risk factors for virus detection in the MEE. MEE samples, collected at the time of myringotomy from 37 children with OME were assessed. Physical examination, skin prick tests and a standardized questionnaire on OME and allergy were also performed. Viral RNA was detected by the use of reverse transcription PCR (RT-PCR). Fifteen samples (40.5%) were positive for rhinovirus (RV). One enterovirus and no other respiratory viruses were detected. Two out of five (40%), 3/7 (43%) and 10/25 (40%) were positive for RV in acute, subacute and chronic cases, respectively. Children with frequent episodes of OM, with early onset of OM (<2 yr old), and a positive family history of allergy had a statistically increased risk of RV detection. The two groups were comparable with respect to all other parameters examined. RV is the predominant virus recovered by RT-PCR in the middle ear cavity of children with asymptomatic OME, especially those with a history of longstanding OME or repeated episodes, or children with a family history of allergy. Interactions between allergy and RV infections are likely to predispose to middle ear disease.

Inflammation in the Middle Ear of Children With Recurrent or Chronic Otitis Media Is Associated With Bacterial Load

“…RV has been shown to play an important role in lower respiratory tract pathology, where it can provoke exacerbations of cystic fibrosis, asthma and chronic obstructive pulmonary disease. 14,[29][30][31] One mechanism by which rhinoviruses can induce inflammation during coinfection with bacterial pathogens is through the liberation of planktonic bacteria from biofilms. This in turn may cause increased recognition by the innate immune system, resulting in an increased cytokine response, as demonstrated in cystic fibrosis airway epithelial cells.…”

Rhinovirus and the developing lung

“…However a recent study examining the prevalence of HRV infections on high risk infants during different seasons presented data showing that HRV virulence was greatest during winter months [5]. The disease burden of HRV infections has been fully realised with advent of RT-PCR techniques and HRV infections have now been demonstrated as a respiratory pathogen in bronchiolitis [6], pneumonia [7], croup [8] and otitis media [9].…”

Poly(I:C) synergizes with Th2 cytokines to induce TARC/CCL17 in middle ear fibroblasts established from mucosa of otitis media with effusion

“…Acute viral infections often predispose patients to the development of OME. It has recently been reported that about 40% of OME patients have HRV infection in the MEE, and that high rates of HRV detection in MEE are seen not only in chronic or subacute OME but also in acute cases [1]. It is highly probable that these viruses play an important role in the initiation and amplification of inflammation in the middle ear.…”

“…The cause and pathogenesis of OME are considered to be multifactorial, including infection of the tubotympanum, eustachian tube blockage and allergy. Recently, a high frequency of viral infections in middle ear effusion (MEE) has been found in OME in humans [1]. These viruses synthesize double-stranded (ds) RNA during replication in infected cells.…”