Abstract
ABSTRACTInflammation of the middle ear, known clinically as chronic otitis media, presents in different forms, such as chronic otitis media with effusion (COME; glue ear) and chronic suppurative otitis media (CSOM). These are highly prevalent diseases, especially in childhood, and lead to significant morbidity worldwide. However, much remains unclear about this disease, including its aetiology, initiation and perpetuation, and the relative roles of mucosal and leukocyte biology, pathogens, and Eustachian tube function. Chronic otitis media is commonly modelled in mice but most existing models only partially mimic human disease and many are syndromic. Nevertheless, these models have provided insights into potential disease mechanisms, and have implicated altered immune signalling, mucociliary function and Eustachian tube function as potential predisposing mechanisms. Clinical studies of chronic otitis media have yet to implicate a particular molecular pathway or mechanism, and current human genetic studies are underpowered. We also do not fully understand how existing interventions, such as tympanic membrane repair, work, nor how chronic otitis media spontaneously resolves. This Clinical Puzzle article describes our current knowledge of chronic otitis media and the existing research models for this condition. It also identifies unanswered questions about its pathogenesis and treatment, with the goal of advancing our understanding of this disease to aid the development of novel therapeutic interventions.
Highlights
Otitis media (OM; see Box 1 for a glossary of terms) describes an inflammatory disease of the middle ear that consists of a set of interrelated clinical phenotypes
139 families with Recurrent AOM (rAOM) or chronic otitis media with effusion (COME) treated with grommets 468 families with rAOM or COME treated with grommets 403 families with children treated with grommets 1296 families with COME treated with grommets
What are the relative roles of mucosal biology, leukocyte biology, pathogens and Eustachian tube function in the perpetuation and resolution of COME and Chronic suppurative otitis media (CSOM)?
Summary
Otitis media (OM; see Box 1 for a glossary of terms) describes an inflammatory disease of the middle ear that consists of a set of interrelated clinical phenotypes. Chronic suppurative otitis media (CSOM; Box 1) is characterised by a persistent perforation of the tympanic membrane (Box 1, Fig. 2) with intermittent or constant discharge of pus through this perforation (a condition known as otorrhoea; Box 1 and see the accompanying case study in Box 2). After an episode of AOM, the middle ear effusion becomes non-purulent [otitis media with effusion (OME); Box 1] and usually resolves within days; in an estimated 8% of affected children it persists for more than 3 months and becomes chronic (COME) (Bhutta, 2014). Examination with an otoscope reveals evidence of effusion behind the tympanic membrane (see Fig. 1), giving a diagnosis of otitis media with effusion (OME; or ‘glue ear’) These cell-culture models enable host-pathogen interactions to be assessed at the epithelial surface
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