Etiology Of Otitis Media Research Articles

Skeletal Evidence for Otitis Media in Mediaeval and Post‐Mediaeval Children from Poland, Central Europe

AbstractIn palaeopathological research, otitis media (OM) is a rarely reported disease, although it is one of the most common diseases of childhood, with potentially severe consequences resulting in physical and social impairment, or even death. The episodes of OM are often preceded by upper respiratory tract infections, though the aetiology of OM is multifactorial, with significant role of environmental factors. In archaeological skeletons, middle ear inflammation is identified as erosive lesions and new bone formation of auditory ossicles. The aim of this study was to examine the skeletal signs of OM in children from a mediaeval early urban site (Cedynia) and a post‐mediaeval rural site (Słaboszewo) located on the territory of Poland. Among the entire sample (N = 435), ear bones were present in 99 skeletons. The total of 168 ossicles were examined. The general frequency of individuals with eroded ossicles was 47.5% (53.4% in Cedynia and 39.0% in Słaboszewo). In the total sample, 33.9% of ear bones showed pathological changes, with the incudes being most frequently affected. The frequency of altered ossicles was significantly higher in the early urban site than in the rural settlement (42.2% vs 25.9%, respectively; Fisher exact test, p = 0.0339). The children aged 0–3 years old tend to have a higher frequency of altered ear bones than the children aged 4–11 years old. The majority of the mastoid processes of the subadults with ear bone erosion show abnormal pneumatisation pattern. The results indicate that the environmental and socio‐cultural conditions in the stronghold likely made their inhabitants more prone to upper respiratory tract infections than the inhabitants of the village. A variety of factors may be responsible for this pattern, such as exposure to dust, environmental pollution, indoor pollution, wood smoke, occupation, population density, sanitation and quality of housing. Copyright © 2016 John Wiley & Sons, Ltd.

PREVALENCE AND RISK FACTORS OF OTITIS MEDIA WITH EFFUSION IN SCHOOL AGE CHILDREN

Otitis media with effusion, which refers to the accumulation of fluid in the middle ear cavity without any signs of infection, is a common health problem both in pre-school and school age children. The etiology of otitis media with effusion is multifactorial and many risk factors may increase its incidence. The aim of this study is to determine the frequency and risk factors of otitis media with effusion in school age children in Basrah. In this descriptive prospective study; sixty patients aged between 6-12 years were included; they were 34 males and 26 females diagnosed as having otitis media with effusion in the period between July 2013 to April 2014; at Basrah General Hospital, Iraq. Pure tone audiometry, tympanometry, and lateral x-ray film of post nasal space were done for each patient after a full ENT history and examination . A questionnaire form was constructed to apply for each patient including the possible risk factors for developing otitis media with effusion such as age group, gender, parental smoking, allergy, history of acute infection, maternal education, family income, school type. Otitis media with effusion was found to be higher (66.7%) in children aged between 6-8 years, males more than females with male to female ratio 1.3:1. (61.6%) were from rural area, parental smoking present in (65%), (58.3%) had history of allergy, (66.6%) with history of upper respiratory tract infection, low maternal educational level, low financial income (66.6%), attendance to public school, and the presence of adenoid hypertrophy (71%) were found to be associated with otitis media with effusion. Conclusion and Recommendation: Environmental, epidemiologic and familial factors play an important role in etiology of otitis media with effusion. The parents must be informed about these modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.

Bacterial aetiology of otitis media in children in Pakistan aged 0–59 months; laboratory surveillance data from 2004 to 2013: comparison between before and after the introduction of Hib vaccination

Background:Otitis media (OM) is a leading cause of childhood illness. In Pakistan, the estimated incidence of OM-associated hearing impairment is >40/10,000 population and OM-associated mortality is 50–79·9/10×106 population. No OM microbiology data are available from Pakistan since 2004.Objectives:To describe the microbiology of OM in children aged 0–59 months in Pakistan.Methods:Laboratory data on ear pus specimens taken from children seen between 2004 and 2013 were retrieved from the Laboratory Information Systems of the Aga Khan University and entered into Microsoft Excel and SPSS version 16.0.Results:Bacterial culture results from 277 specimens were analysed. Staphylococcus aureus and Pseudomonas aeruginosa were the organisms most commonly isolated, followed by Streptococcus pneumoniae and Haemophilus influenzae. Polymicrobial cultures significantly increased in the post-Hib vaccination period from 19·5% to 32·7% (P = 0·038). H. influenzae also increased significantly from 16·8% to 24·5% (P = 0·038)....

Bacterial aetiology of otitis media in children in Pakistan aged 0–59 months; laboratory surveillance data from 2004 to 2013: comparison between before and after the introduction of Hib vaccination

Background:Otitis media (OM) is a leading cause of childhood illness. In Pakistan, the estimated incidence of OM-associated hearing impairment is >40/10,000 population and OM-associated mortality is 50–79·9/10×106 population. No OM microbiology data are available from Pakistan since 2004.Objectives:To describe the microbiology of OM in children aged 0–59 months in Pakistan.Methods:Laboratory data on ear pus specimens taken from children seen between 2004 and 2013 were retrieved from the Laboratory Information Systems of the Aga Khan University and entered into Microsoft Excel and SPSS version 16.0.Results:Bacterial culture results from 277 specimens were analysed. Staphylococcus aureus and Pseudomonas aeruginosa were the organisms most commonly isolated, followed by Streptococcus pneumoniae and Haemophilus influenzae. Polymicrobial cultures significantly increased in the post-Hib vaccination period from 19·5% to 32·7% (P = 0·038). H. influenzae also increased significantly from 16·8% to 24·5% (P = 0·038).Conclusions:An increase in H. influenzae may reflect non-b capsular types (not determined in the study), or even capsular types from areas with low vaccine coverage. Increases in polymicrobial cultures and H. influenzae warrant further study.

Otopathogens Detected in Middle Ear Fluid Obtained during Tympanostomy Tube Insertion: Contrasting Purulent and Non-Purulent Effusions.

Otitis media is a prominent disease among children. Previous literature indicates that otitis media is a polymicrobial disease, with Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis and Moraxella catarrhalis being the most commonly associated bacterial pathogens. Recent literature suggests that introduction of pneumococcal conjugate vaccines has had an effect on the etiology of otitis media. Using a multiplex PCR procedure, we sought to investigate the presence of the aforementioned bacterial pathogens in middle ear fluid collected from children undergoing routine tympanostomy tube placement at Wake Forest Baptist Medical Center during the period between January 2011 and March 2014. In purulent effusions, one or more bacterial organisms were detected in ~90% of samples. Most often the presence of H. influenzae alone was detected in purulent effusions (32%; 10 of 31). In non-purulent effusions, the most prevalent organism detected was A. otitidis (26%; 63 of 245). Half of the non-purulent effusions had none of these otopathogens detected. In purulent and non-purulent effusions, the overall presence of S. pneumoniae was lower (19%; 6 of 31, and 4%; 9 of 245, respectively) than that of the other pathogens being identified. The ratio of the percentage of each otopathogen identified in purulent vs. non-purulent effusions was >1 for the classic otopathogens but not for A. otitidis.

Prevalence of Fungal Infection in Chronic Suppurative Otitis Media-A Study at Tertiary Care Hospital in Western Uttar Pradesh

Background: Chronic otitis media (CSOM) is a notorious infection prevalent mostly in developing countries due to indiscriminate uses of local steroid and antibiotics in the ear either alone or combination. Humidity also plays a major contributing factor in the etiology of otitis media. Objective: To know the prevalence of fungal infection in chronic suppurative otitis media. Method: The study was conducted on 130 cases of recurrent discharging ear at the out patient door of Deptt of E.N.T and Dept. of Microbiology, Rohilkhand Medical College and Hospital, Bareilly. Results: Out of 130 cases, 34 were found fungal positive having the prevalence rate 26.15%. The side of involvement was more common in right ear (66.66%) than left. Males are affected more (58.82%) than females. Most of the fungal infections were associated with the use of local steroid and antibiotics (79.41%). Predominent fungal isolates were Aspergillus spp. (32.35%) followed by other saprophytic fungi (52.94%). Key words: Chronic suppurative otitis media, Fungal infection, Steroid and antibiotics

Can Helicobacter pylori cause inflammation in the middle ear?

ObjectivesTo investigate whether Helicobacter pylori causes inflammation in the normal middle ear and in the middle ear with effusion. MethodsSixteen adult New Zealand white rabbits were divided into two gropus equally. Group I was representing histamine-induced middle ear inflammation and Group II was representing normal middle ear. While H. pylori was inoculated in the right ears, physiologic saline was inoculated in the left ears of the rabbits in both groups. Results were evaluated clinically, histopathologically and microbiologically. Fisher's exact test was used for statistical analysis. ResultsIn Group I, clinical scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Histopathological scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Also, H. pylori was isolated in 6 of the 8 right ears of the rabbits. In Group II, while clinical scores of the inflammation in the right ears scores were higher than the left ears scores at the 7th day, histopathological scores were not significantly different between both ears. Also, no H. pylori was isolated in right ears of the rabbits. ConclusionsEffusion in the middle ear induced by histamine is an appropriate medium for H. pylori reproduction and it also aggravates the inflammation process. In contrary, H. pylori did not cause inflammation in the normal middle ear. We suggest that H. pylori does not play a role in the etiology of otitis media with effusion alone, but it contributes to the inflammation process in the presence of an effusion.

Ectopic Mineralization in the Middle Ear and Chronic Otitis Media with Effusion Caused by RPL38 Deficiency in the Tail-short (Ts) Mouse

Inflammation of the middle ear cavity (otitis media) and the abnormal deposition of bone at the otic capsule are common causes of conductive hearing impairment in children and adults. Although a host of environmental factors can contribute to these conditions, a genetic predisposition has an important role as well. Here, we analyze the Tail-short (Ts) mouse, which harbors a spontaneous semi-dominant mutation that causes skeletal defects and hearing loss. By genetic means, we show that the Ts phenotypes arise from an 18-kb deletion/insertion of the Rpl38 gene, encoding a ribosomal protein of the large subunit. We show that Ts mutants exhibit significantly elevated auditory-brain stem response thresholds and reduced distortion-product otoacoustic emissions, in the presence of normal endocochlear potentials and typical inner ear histology suggestive of a conductive hearing impairment. We locate the cause of the hearing impairment to the middle ear, demonstrating over-ossification at the round window ridge, ectopic deposition of cholesterol crystals in the middle ear cavity, enlarged Eustachian tube, and chronic otitis media with effusion all beginning at around 3 weeks after birth. Using specific antisera, we demonstrate that Rpl38 is an ∼8-kDa protein that is predominantly expressed in mature erythrocytes. Finally, using an Rpl38 cDNA transgene, we rescue the Ts phenotypes. Together, these data present a previously uncharacterized combination of interrelated middle ear pathologies and suggest Rpl38 deficiency as a model to dissect the causative relationships between neo-ossification, cholesterol crystal deposition, and Eustachian tubes in the etiology of otitis media.

TLR4-mediated induction of TLR2 signaling is critical in the pathogenesis and resolution of otitis media

Otitis media is the most prevalent childhood disease in developed countries. The involvement of Toll-like receptors (TLRs) in otitis media pathophysiology has been implicated by studies in cell lines and association studies of TLR gene polymorphisms. However, precise functions of TLRs in the etiology of otitis media in vivo have not been examined. We investigated the inflammatory response to nontypeable Haemophilus influenzae using a model of otitis media in wild-type, TLR2(- /-) and TLR4(-/ -) mice by gene microarray, qPCR, immunohistochemistry, Western blot analysis and histopathology. Toll-like receptor-2(- /-) and TLR4(- /-) mice exhibited a more profound, persistent inflammation with impaired bacterial clearance compared to controls. While wild-type mice induced tumor necrosis factor-a (TNF) after non-typeable H. influenzae challenge, TLR2(-/-) and TLR4(-/-) mice lack TNF induction in the early phase of otitis media. Moreover, lack of TLR2 resulted in a late increase in IL-10 expression and prolonged failure to clear bacteria. Toll-like receptor-4(-/- ) mice showed impaired early bacterial clearance and loss of TLR2 induction in early otitis media. Our results demonstrate that both TLR2 and TLR4 signalling are critical to the regulation of infection in non-typeable H. influenzae-induced otitis media. Toll-like receptor-4 signalling appears to induce TLR2 expression, and TLR2 activation is critical for bacterial clearance and timely resolution of otitis media.

Pneumococcal conjugate vaccination and otitis media: differences among high-risk and low-risk populations

Evaluation of: Mackenzie GA, Carapetis JR, Leach AJ, Morris PS. Pneumococcal vaccination and otitis media in Australian Aboriginal infants: comparison of two birth cohorts before and after introduction of vaccination. BMC Pediatr. 9, 14 (2009).The impact of the heptavalent pneumococcal conjugate vaccine (PCV7) on the natural history of otitis media (OM) has been studied recently. In a high-risk population, PCV7 significantly reduced the risk of recurrent, bilateral or multiple tympanic membrane perforation, as well as the risk of chronic suppurative OM at 9 months of age. PCV7 did not reduce the time to the development of OM nor the burden of OM. Major challenges are the polymicrobial etiology of OM (Streptococcus pneumoniae and Haemophilus influenzae) in high-risk populations and the serotype replacement among pneumococcal strains. A vaccine including nontypable H. influenzae and 11 pneumococcal serotypes has been identified as a more efficacious option for preventing OM. In the near future, the development and evaluation of a vaccine containing pneumococcal protein, such as pneumococcal surface protein A, which is a structurally variable and serologically cross-reactive surface protein important to the pneumococcal virulence, will be a potential tool against OM.

Prevalência elevada do Alloiococcus otitidis na otite média com efusão através da PCR simultânea

A etiologia da otite média com efusão (OME) não é completamente conhecida, mas agentes infecciosos podem contribuir para sua patogênese. O conhecimento sobre a epidemiologia bacteriana da OME em áreas geográficas distintas é essencial para a implementação de tratamentos racionais, quando indicados. OBJETIVO: Determinar a prevalência do Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis e Alloiococcus otitidis nas efusões da orelha média de crianças com otite média recorrente (OMR) e otite média com efusão crônica (OMEC) que foram submetidas à miringotomia e comparar os resultados obtidos por cultura e PCR. FORMA DE ESTUDO: Estudo clínico com coorte transversal. MATERIAL E MÉTODO: 128 efusões obtidas por timpanocentese de 75 crianças entre 11 meses e 10 anos de idade foram analisadas por cultura e PCR simultânea. RESULTADOS: Cultivaram-se bactérias em 25,1% das amostras e os patógenos principais foram encontrados em 19,6%. O A.otitidis não foi isolado em cultura. A PCR identificou bactérias em 85,9%, com os seguintes resultados individuais: A.otitidis, 52,3%; H.influenzae, 39,1%; S.pneumoniae, 12,5% e M.catarrhalis, 10,2%. A PCR foi significativamente mais sensível que a cultura (P<0,01). O S.pneumoniae foi mais encontrado em OMR do que em OMEC (P=0,038). CONCLUSÕES: A prevalência das bactérias na OME em um grupo de crianças brasileiras é semelhante àquelas relatadas em outros países, sendo o H.influenzae o mais encontrado dentre os patógenos principais da orelha média. O S.pneumoniae foi mais freqüente em OMR do que em OMEC. A PCR é mais sensível na detecção de bactérias na efusão da orelha média, comparada com cultura, e é essencial para a identificação do A.otitidis. O elevado percentual de detecção do A.otitidis sugere mais investigações sobre sua atuação no início e no prolongamento de doenças da orelha média.

Autoimmunity in the etiology of otitis media with effusion

Otitis media with effusion (OME) is one of the most common health problems seen in children. The role of autoimmunity in the etiology of OME has been discussed for a long time. The purpose of this investigation is to determine the role of circulating antibodies in the pathogenesis of OME. The presence of antibodies against rabbit tympanic bulla epithelium was investigated by indirect immunoflouresence in the serum samples of 25 patients with OME and serum samples of 25 healthy children as a control group. In the control group, positive staining was seen in only 1 case (4%), whereas 8 cases with OME were positively stained (%32). There was statistically significant difference between the 2 groups. The presence of antibodies against middle ear epithelium in the cases with OME suggest that autoimmunity might play a role in the formation of effusion in the tympanic cavity.

In Vitro Study of IL-8 and Goblet Cells: Possible Role of IL-8 in the Aetiology of Otitis Media with Effusion

One of the main characteristics of otitis media with effusion (OME) is the differentiation of basal cells into goblet cells with subsequent proliferation in a modified respiratory epithelium leading to the formation of mucin-rich effusion in the middle ear cleft. In order to determine the effect of pro-inflammatory cytokines identified in OME, e.g. IL-1 g , tumour necrosis factor (TNF)- f , IL-6 and IL-8, on goblet cells, and to clarify the role of IL-8 in particular, we used the human goblet cell line HT29-MTX, which secretes two OME-related mucins: MUC5AC and MUC5B. IL-1 g and TNF- f stimulated the secretion of IL-8 in HT29-MTX goblet cells. Dose- (2-200 ng ml) and time- (0-5 days) response studies of IL-8-induced mucin secretion were carried out. IL-8 upregulated the secretion of MUC5AC and MUC5B mucins in a concentration-dependent manner, with a maximum response at an IL-8 concentration of 20 ng ml. IL-8 (20 ng ml)-mediated mucin secretion persisted for up to 5 days, with a peak response 72 h after the addition of cytokine. These results suggest that: (i) goblet cells are target cells for the pro-inflammatory cytokines IL-1 g , TNF- f and IL-8 and can contribute to the pathogenesis of OME by increasing both the concentration of IL-8 and the secretion of mucin; and (ii) IL-8 stimulates prolonged mucin secretion from goblet cells and may be involved in the maintenance of the disease in the chronic stage.

TNF-ALPHA IN THE REGULATION OF MUC5AC SECRETION: SOME ASPECTS OF CYTOKINE-INDUCED MUCIN HYPERSECRETION ON THE IN VITRO MODEL

TNF-α has been implicated in the aetiology of otitis media with effusion (OME), where goblet cells proliferate in a modified respiratory epithelium, leading to the accumulation of a mucin-rich effusion in the middle-ear cleft. The MUC5AC mucin gene product has been identified as a component of these effusions. Here we have used the HT29-MTX goblet cell line, which secretes MUC5AC mucin, as a model to study the effect of TNF-α on goblet cells. MUC5AC mucin was identified and quantitated with a monoclonal antibody NCL-HGM-45M1. TNF-α stimulates MUC5AC mucin secretion in a dose-dependent manner, with 20ng/ml producing maximal stimulation. Both pre-confluent and confluent cells showed peak stimulation after 7h, however the pre-confluent cells showed twice the level of mucin hypersecretion. These results suggest that TNF-α stimulation of mucin secretion could play an important role in the early acute phase of the development of OME. This hypersecretion of mucin could then lead to the failure of the mucociliary clearance system, resulting in the accumulation of a mucin-rich effusion in the middle ear and the movement to a more chronic phase of the disease.

The aetiology of otitis media with effusion: a review.

Otitis media with effusion (OME) is the most common cause of deafness in children in the developed world. In this article we aim to present an overview of current research developments on the aetiology of OME and the resulting implications for treatment. In the model we describe, the primary event is inflammation of the middle ear mucosa, usually due to the presence of bacteria. This leads to the release of inflammatory mediators, which cause secretion of a mucin-rich effusion by up-regulating mucin genes. Prolonged stimulation of the inflammatory response and poor mucociliary clearance lead to persistence of the middle ear fluid, giving rise to the clinical presentation of OME. We describe OME in the following sequence: the initial production of the effusion, the composition of the effusion produced, and factors impairing clearance of the effusion.

High incidence of Alloiococcus otitis in otitis media with effusion.

The etiology of otitis media with effusion (OME) is unclear. Although the majority of effusions show inflammation, culture methods yield positive results for bacteria in only 20 to 30% of cases. The polymerase chain reaction was used for detection of three upper respiratory tract pathogens, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae, and a fairly recently described bacterium, Alloiococcus otitis (A. otitidis), that is solely found in OME. The study included 67 middle ear effusions that were collected from 48 pediatric OME patients during ventilation tube placement. PCR tested positive for 57 (85.1%) of the middle ear effusions. Thirty-one (46.3%) A. otitis-, 12 (17.9%) H. influenzae-, 25 (37.3%) M. catarrhalis- and 14 (20.9%) S. pneumoniae-positive effusions were obtained. All four study organisms showed similar distribution in effusions of various duration (P = 0.72) and in different effusion types (P = 0.59). Only the proportion of M. catarrhalis-positive effusions was lowered by recent antimicrobial therapy (P < 0.05). Although the study organisms had equal distributions among singly and multiply positive specimens (P = 0.90), A. otitis was detected significantly more often with one of the three other species (15 of 19, 78.9%) than the other species with each other (4 of 19, 21.1%, P < 0.001). The findings suggest a bacterial etiology for OME. Association of A. otitis with the three other species implies that this organism might have the capability of augmenting bacterial colonization in the middle ear.

Association of Chlamydia pneumoniae with otitis media in children.

Chlamydia pneumoniae is a common cause of acute and persistent respiratory tract infections. The prevalence of C. pneumoniae was studied using the polymerase chain reaction (PCR) in throat swabs from 85 consecutive children with respiratory tract infections and 86 healthy children. In retrospect, it became evident that this study was conducted in the midst of a local C. pneumoniae epidemic. 38 (45%) of the sick children and 5 (5.7%) of the healthy children were positive for C. pneumoniae by PCR. 26 of the sick children (mean age 6.4 years) were found to have otitis media either at the time of examination or shortly thereafter. Six of 9 children with acute otitis media were PCR positive for C. pneumoniae and 7 of the 9 had specific antibody responses indicating active infection. 10 of 17 children diagnosed as having otitis media with effusion were found to be positive for C. pneumoniae by PCR. Seven children had or developed persistent otitis media with effusion. Chlamydia pneumoniae was demonstrated by PCR from the middle ear fluid in 1 of the children. The results obtained from this study indicate that C. pneumoniae may be involved in the aetiology of otitis media.

The effect of indoor air pollutants on otitis media and asthma in children

This case-control study investigated the possible association between home environmental air pollutants and their effect on otitis media and asthma in children. Patients with physician-diagnosed otitis (n = 125, 74% response), with asthma (n = 137, 80% response), and controls (n = 237, 72% response) from a private pediatric practice seen between October 1986 and May 1987 were studied. A questionnaire inquired about housing characteristics (i.e., age, insulation, heating system) and sources of indoor air pollution such as cigarette smoking, use of woodburning stoves, household pets, etc. Analysis of the responses confirmed previous findings of significant relationships between maternal smoking (P = .021), and the presence of pets (P = .034) and the occurrence of asthma. A newly reported relationship between exposure to woodburning stoves and the occurrence of otitis (P less than .05) was reported. This implicates yet another risk factor (wood burning) in the etiology of otitis media.

しん出性中耳炎例の鼻腔粘液線毛機能 サッカリンテストによる

The etiology of otitis media with effusion (OME) is still unknown. However, an inflammatory reaction to a bacterial infection originating in the nasopharynx is thought to be one of the main factors responsible for OME, and impaired mucociliary clearance of the nose and nasopharynx may increase the chance of infection through the Eustachian tube.Nasal mucociliary function was examined with the saccharin test in 115 noses of 61 patients with OME aged 8 to 92 years. Myringotomies were performed in almost all cases and aspirated middle ear effusions were classified into serous, mucoid and purulent types.1) Prolonged saccharin times (over 11 minutes) were noted in 84.3% of 61 patients with OME.2) The patients were divided into two proups; 35 patients had OME and chronic sinusitis (group A) and 26 patients had OME without sinusitis (group B). Prolonged saccharin times were found in 86.4% in group A and 81.6% in group B—not a statistically significant difference.3) Greatly prolonged saccharin times (over 30 minutes) were found in 45.5% in group A and 14.3% in group B—a significant difference. Thus, mucociliary function in the nose was thought to be impaired more severely in group A than group B.4) Bilateral OME and mucoid type effusion were found more frequently in group A than group B.5) The main cause of impaired nasal mucociliary function in group A was thought to be chronic inflammation of the nasal mucosa. On the other hand, acute upper respiratory infection preceding the development of OME was assumed to cause impaired nasal mucociliary clearance in group B.However, in group B, impaired nasal mucociliary function may be congenital in some cases without inflammatory findings by anterior rhinoscopy or episodes of acute upper respiratory infection

Otitis Media and Its Relationship to Allergy

The importance of infection in the etiology of otitis media and the role of eustachian tube obstruction in the pathogenesis of otitis media with effusion are well known. Recently, allergic rhinitis has been documented to induce eustachian tube obstruction. When allergic rhinitis is diagnosed in a child with recurrent or chronic middle ear disease, allergy should be considered as another risk factor for the development of otitis media with effusion.