Middle Ear Effusion In Patients Research Articles

Clinical observation of Otitis Media Secretory during Covid-19.

This study aims to analyze the onset of otitis media secretory, the peak period of infection with the Omicron strain of SARS-CoV-2 virus, and the time of transmigration during a pandemic of the Omicron strain. Additionally, the study aims to investigate to study the presence of SARS-CoV-2 virus in the middle ear cavity of patients with otitis media secretory and the survival time through a new method for detecting SARS-CoV-2 virus antigen in middle ear effusion. Retrospective comparison of the incidence of otitis media secretory during infection with SARS-CoV-2 virus Omicron strain from December 15, 2022, to January 15, 2023, versus the noninfection period from December 15, 2021, to January 15, 2022. We used a questionnaire star application to investigate the demographic and epidemiological characteristics of the 40 patients with otitis media secretory who participated in this study were investigated. A novel coronavirus (2019-nCoV) antigen detection kit (colloidal gold method) was used to detect middle ear effusion in patients with otitis media secretory. The data were statistically analyzed using SPSS 29.0 software. The measurement data are expressed as x ± s , the count data are expressed as the number of cases (%), and the data were compared using the χ 2 test. p < 0.05 indicated a statistically significant difference. During the SARS-CoV-2 virus Omicron strain pandemic, the incidence of otitis media secretory increased by 15% compared with the noninfection period. The peak infection period for the SARS-CoV-2 virus Omicron strain was December 25, 2022, and December 15, 2022, and the peak time of conversion was 7 to 9 days after the infection. Middle ear effusion SARS-CoV-2 virus antigen testing was performed in patients with otitis media secretory after conversion; 5 patients (12%) were positive, and 35 patients (88%) were negative. The disease duration in patients with negative results was more than 3 weeks. Otitis media secretory is one of the most common ear complications after infection with the Omicron strain of SARS-CoV-2 virus, and the significantly higher incidence is associated with middle ear viral infection. Middle ear effusion SARS-CoV-2 virus antigen test detected the virus, which survived longer in the middle ear effusion than in the nasal cavity. The middle ear effusion test can detect SARS-CoV-2 virus antigen and determine whether the organism contains virus residue.

The silent reservoir? SARS-CoV-2 detection in the middle ear effusion of patients with Otitis media with effusion after omicron infection

PurposeThis multicenter, prospective study is designed to investigate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the Middle Ear Effusion (MEE) of patients developing Otitis Media with Effusion (OME) subsequent to an Omicron infection. The objective is to elucidate any potential association between the virus and the condition. MethodsThis study, conducted from January to June 2023, spanned the Otolaryngology departments of two medical institutions in Eastern China. Patients manifesting OME subsequent to Omicron infection from both hospitals were subjected to comprehensive otolaryngological assessments, including pure-tone audiometry (PTA), tympanometry, otoscopic examination, and nasopharyngolaryngoscopy. Subsequently, MEE samples extracted from these patients were analyzed through RT-PCR to detect SARS-CoV-2. ResultsIn this study, 23 patients (32–84 years; 57.5 ± 14.8 mean age; 47.8 % male) presented OME in 25 ears post-Omicron infection, with 21 (91.3 %) exhibiting unilateral symptoms. The median duration from infection to MEE sampling was 21 days (IQR: 25–46; range: 11–150). Predominantly, 64.0 % exhibited Type B tympanograms, and fluid accumulation was observed in 88.0 % of ears. SARS-CoV-2 was detected in 3 MEE samples (12.0 %), with cycle threshold values ranging between 25.65 and 33.30. ConclusionsOur study highlights the potential effects of COVID-19 on the middle ear, suggesting a link between SARS-CoV-2 and OME onset. The virus, a significant contributor to OME, is detectable in the MEE nearly a month post-Omicron infection, indicating a potential alteration in OME treatment strategies and a risk of recurrence, emphasizing the necessity for otolaryngologist vigilance.

Myringoplasty for Eosinophilic Otitis Media.

Surgical intervention of eosinophilic otitis media (EOM) has been considered contraindicated because middle ear surgery is associated with a risk of deafness. Myringoplasty is believed to be less invasive. Therefore, we analyzed the surgical results of myringoplasty for perforated eardrums in patients with EOM treated by biological drugs (biologics). Retrospective chart review. Tertiary referral center. Nine ears of seven patients with EOM with eardrum perforation associated with bronchial asthma were treated with add-on biologics; myringoplasty was then performed. The controls comprised 17 ears of 11 patients with EOM treated by myringoplasty without biologics. The EOM status of each patient of both groups was assessed using severity scores, hearing acuity, and temporal bone computed tomography scores. Preoperative and postoperative changes in severity scores and hearing acuity, postoperative closure of the perforation, and relapse of EOM. Severity scores significantly decreased after the use of biologics but did not change after myringoplasty. One patient developed postoperative relapse of middle ear effusion (MEE); in the control group, however, 10 ears developed recurrence of MEE. Significant improvement of the air conduction hearing level was obtained in the biologics group. No patients showed deterioration of the bone conduction hearing level. This is the first report to describe successful surgical interventions with add-on biologics for patients with EOM. In the era of biologics, surgical interventions such as myringoplasty will be indicated to improve hearing and to avoid recurrence of MEE in patients with EOM with perforated eardrums, with the use of biologics.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part I.

ObjectivesThe aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion.MethodsPatients <15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected.ResultsIn 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected.ConclusionH. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

Distortion product otoacoustic emission together with tympanometry for assessing otitis media with effusion in children

Objective: To investigate the diagnostic value of distortion product otoacoustic emission (DPOAE) together with tympanometry in assessing otitis media with effusion in children.Methods: Three hundred and thirty-nine patients, who were diagnosed with obstructive sleep apnea–hypopnea syndrome (OSAHS) and prepared to undergo adenotonsillectomy and had a unilateral or bilateral type ‘B’ or ‘C’ tympanogram were enrolled in this study. Patients were divided into the following four groups: Group 1, type ‘B’ tympanogram with positive DPOAE; Group 2, type ‘B’ tympanogram with negative DPOAE; Group 3, type ‘C’ tympanogram with positive DPOAE and Group 4, type ‘C’ tympanogram with negative DPOAE.Results: Tympanometry showed a type ‘B’ pattern in 467 ears and type ‘C’ pattern in 163 ears. Among 163 ears with type ‘C’ tympanogram, negative DPOAE results were seen in 96 ears. Group 4 (56/96) had a significant high rate of middle ear effusion than Group 3 (14/67) (p < .05). In patients with a type ‘C’ tympanogram, those with a low compliance value (∼0.25 ml), concurrent chronic tonsillitis and large tonsils are likely to have middle ear effusion.Conclusions: DPOAE could be a great help in screening for middle ear effusion in patients with a type ‘C’ tympanogram.

Study of the role of allergy diagnosed by immunoglobulin E in the etiology of pediatric otitis media with effusion

Objectives This study aimed to study the role of allergy diagnosed by immunoglobulin E (IgE) in the etiology of pediatric otitis media with effusion (OME) by detection of IgE in middle-ear effusion using the enzyme-linked immunosorbent assay technique. Background The role of allergy in chronic OME is controversial. Patients and methods This was a prospective study that was carried out on 80 cases; including 60 pediatric patients diagnosed with chronic OME [resistant to medical treatment for >3 months (type B tympanogram) or recurrent after successful medical treatment]. Patients were subjected to a myringotomy with insertion of a tympanostomy tube (grommet tube). Their age ranged from 2 to 15 years. Twenty children had ENT disease other than OME, mostly adenoidal or tonsillar hypertrophy. The serum level of total IgE was assayed in patients and control groups as well as in the middle-ear effusion of patients. Results The results showed that total IgE was higher in the serum of patients with OME than the serum of the control group; there was a high significant correlation between total IgE in serum and total IgE in effusion in patients with OME. Conclusion Allergy is a possible risk factor for the development of pediatric OME.

Increased IL-17 and 22 mRNA expression in pediatric patients with otitis media with effusion

ObjectivesMiddle ear effusion has been reported to be associated with immune responses in patients with otitis media with effusion (OME). Although various cytokines are involved in immunologic responses in patients with OME, no study to date has assessed the involvement of the pro-inflammatory cytokines interleukin (IL)-17 and IL-22. This study analyzed the levels of expression of IL-17 and IL-22 in the middle ear effusion of patients with OME. MethodsPatients aged <11 years who were diagnosed with chronic OME and underwent ventilation tube insertion from May 2013 to August 2015 were enrolled. Effusion fluid samples were obtained during surgery and levels of IL-17 and IL-22 mRNAs assessed by real-time PCR. IL-17 and IL-22 mRNA levels were compared in patients with effusion fluid positive and negative for bacteria; in patients with and without accompanying diseases, recurrent disease, and re-operation; and relative to fluid characteristics. ResultsThe study cohort included 70 pediatric patients, 46 boys and 24 girls, of mean age 4.31 ± 2.11 years. The levels of IL-17 and IL-22 mRNA were higher in patients with than without sinusitis, but only IL-22 mRNA levels differed significantly (p < 0.05). The level of IL-17 mRNA was significantly higher in patients who did than did not undergo T&A (p < 0.05). The level of IL-22 expression was significantly higher in mucoid and purulent middle ear fluid samples than in serous fluid samples (p < 0.05). ConclusionIL-17 and IL-22 mRNAs are involved in the pathophysiology of OME and are significantly higher in subjects with than without accompanying diseases.

Functional MRI of the Eustachian Tubes in Patients With Nasopharyngeal Carcinoma: Correlation With Middle Ear Effusion and Tumor Invasion.

We sought to combine the Valsalva maneuver with MRI to evaluate eustachian tube function in patients with nasopharyngeal carcinoma (NPC) and to correlate the extent of tumor invasion with the presence of middle ear effusion (MEE) and eustachian tube dysfunction (ETD). We performed MRI along the lengths of the eustachian tubes, before and after the Valsalva maneuver was performed, in 53 patients with untreated NPC. The images were reviewed by two radiologists. A total of 106 eustachian tubes and middle ears were studied. There was dysfunction in 37 eustachian tubes, which was always ipsilateral to the NPC. There was MEE in 26 ears of 22 patients. In all cases of MEE, there was ipsilateral ETD. ETD was correlated with tumor invasion of the ipsilateral pharyngeal recess (p < 0.001), pharyngeal opening of the eustachian tube (p < 0.001), the cartilaginous eustachian tube (p < 0.001), the eustachian cartilage (p < 0.001), Ostmann fat pad (p < 0.001), the levator veli palatine muscle (p < 0.001), and the tensor veli palatine muscle (p < 0.001). There was a strong correlation between the grade of parapharyngeal space invasion and ETD (r = 0.809; p < 0.001) and MEE (r = 0.693; p < 0.001). Combining the Valsalva maneuver with MRI is helpful in assessing the function of the eustachian tube in patients with NPC. The cause of MEE in patients with NPC is dysfunction of the eustachian tube opening, which is associated with tumor invasion around the eustachian tube.

Evaluation of Prevalence and Factors Affecting the Development of Middle Ear Effusion in Patients with Prolonged Intubation in Intensive Care Unit

Objective: Monitorization of patients in intensive care units requires a multidisciplinary approach. As cooperation with unconscious or intubated patients is often not possible, some conditions may be overlooked. The aim of this study is to reveal the incidence and factors affecting otitis media with effusion in ICU patients intubated longer than 7 days. Methods: Twenty patients hospitalized in the intensive care unit of the Gaziosmanpasa Taksim Training and Research Hospital from March to December 2014 were included in the study. The Gaziosmanpasa Taksim Training and Research Hospital Ethics Committee approved the study according to the Declaration of Helsinki and Good Clinical Practices guidelines. All of the patients included in the study were aged ≥18 years. Patients intubated because of traffic accidents or trauma, patients with a history of chronic otitis media or ear, nose, and throat operations, patients with head and neck tumors, and patients with tympanic membrane perforation, external auditory canal pathology, nasopharyngeal mass, and chronic sinusitis as well as patients with a pathology leading to nasal obstruction, such as nasal polyposis or severe septal deviation, were excluded. After a detailed history by patients’ relatives, an otoscopic examination, nasal examination, tympanometry, and acoustic reflex measurements were performed. Ear examination was performed using a conventional portable otoscope. Results: Among 20 patients, 12 had bilateral effusion (24 out of 40 ears, 60%). In two patients, a type C tympanogram was obtained (four out of 40 ears, 10%), and the remaining 12 ears of six patients were normal (30%). When intubation time is evaluated, among 13 patients intubated longer than 14 days, 11 had effusion (84%). A significant correlation was found between the duration of intubation and effusion development. Assessing the state of consciousness, 11 of 12 unconscious patients (91%) were found to have effusion. There was a significant correlation between effusion development and state of consciousness. Conclusion: In unconscious patients intubated longer than 14 days, the risk of having middle ear effusion is demonstrated to be higher. Consequently, in the periodic follow-up of intensive care patients with prolonged intubation, a routine otoscopic examination has to be considered. (JAREM 2015; 5: 64-7)

Antigen-specific IgE in middle ear effusion of patients with eosinophilic otitis media

BackgroundEosinophilic otitis media (EOM) is an intractable otitis media characterized by a highly viscous effusion that contains eosinophils. We previously reported that high levels of IgE were detected in middle ear effusion (MEE) of patients with EOM. ObjectiveTo examine antigen-specific IgE in MEE of patients with EOM to clarify the pathogenesis of EOM. MethodsTwenty-six patients with EOM associated with bronchial asthma were included in this study. Antigen-specific IgE against inhalant and bacterial antigens were measured in the serum and MEE of these patients. ResultsIn patients with EOM, 1 or more antigen-specific IgEs were detected from the MEE of 16 of 26 patients (62%), whereas 1 of 9 control patients (11%) had antigen-specific IgE (P < .01). Total serum IgE concentrations were not different between the groups who tested positive (16 patients) and negative (10 patients) for antigen-specific IgE. None of the fungi-specific IgEs were detected in serum even though 11 patients tested positive for 1 or more fungal antigens detected in MEE. The severity score of EOM in the antigen-specific IgE–positive group was significantly higher than that in the antigen-specific IgE–negative group (P < .05). ConclusionAntigen-specific IgE against inhalant and bacterial antigens may be locally produced in the middle ear mucosa in patients with EOM. In particular, local sensitization against fungi together with Staphylococcus aureus could result in local IgE production in the middle ear and may be responsible for the severity of EOM.

Effect of omalizumab on biomarkers in middle ear effusion in patients with eosinophilic otitis media

Conclusions: Eosinophil cationic protein (ECP) concentrations in middle ear effusion (MEE) in patients with eosinophilic otitis media (EOM) were significantly decreased at 3 months after the administration of omalizumab from the baseline level (p < 0.05). This study provides new evidence that omalizumab reduces eosinophilic inflammation in the middle ear and that the reduction of ECP may not be caused by suppression of interleukin (IL)-5 production in the middle ear mucosa. Objective: EOM is an intractable otitis media characterized by a highly viscous effusion containing eosinophils. We recently reported that anti-IgE therapy using omalizumab was efficacious in the treatment of EOM. To clarify the underlying mechanism, we determined changes in biomarkers in MEE related to eosinophilic inflammation after therapy. Methods: Nine patients with EOM received the anti-IgE agent omalizumab for 3 months. Among them, five patients continued anti-IgE therapy for longer than 1 year. Eight EOM patients without administration of omalizumab were also included in the study as controls. The concentrations of eosinophilic inflammatory markers such as ECP, IgE, IL-4, and IL-5 in MEE were measured before and after the administration of omalizumab. Results: After 3 months of omalizumab therapy, the ECP concentration in MEE was significantly reduced from the baseline level (p < 0.05), while no significant change of ECP in the serum was observed. The concentrations of IL-4 and IL-5 in MEE showed no significant change before and after the therapy in EOM patients treated with omalizumab.

Middle Ear Effusion in Adult ICU Patients: A Cohort Study

We conducted a prospective study of 74 adults-34 men and 40 women, aged 18 to 90 (mean: 60.2)-to determine the prevalence of middle ear effusion (MEE) among patients in the setting of an intensive care unit (ICU) and to compare the findings with those of a control group of non-ICU hospitalized patients. Other goals were to identify risk factors associated with MEE in ICU patients and to evaluate any association with fever. Both groups included 37 patients. MEE was present in 19 patients (51.4%) in the ICU group, compared with only 2 patients (5.4%) in the control group (p < 0.01; odds ratio: 18.5; 95% confidence interval: 3.9 to 88.3). In the ICU group, there were statistically significant associations between MEE and both the use of mechanical ventilation (p = 0.03) and the use of sedation (p = 0.02). No significant relationships were seen in terms of length of stay, body position, the use of an endotracheal tube, the length of ventilation, and the use of a feeding tube. Fever was present in 8 ICU patients (21.6%) and 3 controls (8.1%), but none of the fevers was associated with MEE. We conclude that adult ICU patients have a high prevalence of MEE (51.4% in our sample) that is perhaps unrecognized. We believe that MEE in these patients is most likely related to altered consciousness, sedation, and mechanical ventilation. MEE was an unlikely cause of fever.

Middle Ear Effusion in Patients with Sinonasal Cancer Treated by Surgery with or without Radiotherapy

To identify the prevalence and risk factors of eustachian tube dysfunction after surgery for sinonasal cancer by observing the occurrence of middle ear effusion. Historical cohort study. Academic university hospital. Clinical records of 112 patients surgically treated for sinonasal cancer over a 16-year period were evaluated. Initial bivariate analysis was followed by a multivariate logistic regression model. The best model included 2 variables: posterior extension of surgical resection (nasopharynx, soft palate, eustachian tube, pterygomaxillary fossa, parapharyngeal space) with an odds ratio of 5.662 (95% confidence interval [CI], 1.877-9.447) and postoperative radiotherapy with an odds ratio of 8.691 (95% CI, 4.187-13.194). Despite the limited number of patients, the study gives a prediction of middle ear effusion based on 2 well-defined factors: surgical resection of anatomic structures involved in tubal function and adjuvant radiotherapy.

Middle Ear Effusion and Fungi

Bacteria and viruses are rarely isolated from the middle ear fluid in cases of otitis media with effusion (OME). However, since endotoxins are often detected in such effusions, it is suspected that patients with OME have a previous history of gram-negative infection. Recently, fungi have drawn attention as microorganisms that cause chronic sinusitis. We investigated the involvement of fungi in the formation of middle ear effusions of patients with OME and eosinophilic otitis media, in which patients have viscous middle ear effusions and a history of adult bronchial asthma indicating definite involvement of eosinophils. Middle ear effusions and nasal secretions were collected from patients with eosinophilic otitis media (7 patients) or OME (12 patients), and smears were prepared for methenamine silver staining. The remaining specimens were embedded in Epon and stained with toluidine blue for observation under a light microscope, and ultrathin sections were prepared for examination under an electron microscope. Fungal hyphae were detected in the middle ear fluid in all of the patients with eosinophilic otitis media or OME. Charcot-Leyden crystals (CLCs) were observed in 6 of the 7 patients with eosinophilic otitis media. In regard to the findings in the nasal secretions, fungal hyphae were also detected in the nasal secretions of all patients, whereas CLCs were detected in only 1 patient with eosinophilic otitis media. It was clarified by use of the methenamine silver staining method that fungi were present in the middle ear fluid in 100% of the studied cases of eosinophilic otitis media or OME. Whether fungi are also present in the middle ear cavity of normal persons is unknown, but the possibility that they may contribute as a cause of both diseases cannot be excluded. Particularly in eosinophilic otitis media, the observation of numerous CLCs in the middle ear fluid suggests that many eosinophils have degenerated. The eosinophil granule proteins released from the degenerated eosinophils can cause epithelial injury of the middle ear. The possibility that fungi induce the eosinophils in the middle ear also cannot be excluded.

Negative middle ear pressure and otitis media with effusion after surgery under general anesthesia

Conclusion: Negative middle ear pressure was observed in many patients and otitis media with effusion (OME) developed in 3.3% of ears after surgery under general anesthesia. Gas dynamics in the middle ear cavity induced by nitrous oxide inhalation anesthesia and transient blockage of the eustachian tube induced by surgery are considered to be involved in development of OME after surgery under general anesthesia. Objectives: The goal of this prospective study was to investigate middle ear pressure and the prevalence of middle ear effusion in patients after surgery under general anesthesia, to ascertain whether surgery under general anesthesia induces OME. Methods: Otoscopic inspection and tympanometry were performed before surgery (Pre), 1–2 days after surgery (Post-1), and 5–9 days after surgery (Post-2) under general anesthesia in 180 ears of 97 adult patients. Results: Effusion accumulated in the tympanum in six ears (3.3%) of five patients at Post-1. All patients were anesthetized with nitrous oxide. At Post-2, effusion disappeared in all cases. The mean middle ear pressure in all ears was −17.8 daPa at Pre and −60.6 daPa at Post-1, showing a significant reduction from Pre to Post-1 (p < 0.001). At Post-2, the pressure was −18.4 daPa, with no significant difference from that at Pre (p = 0.74).

Gel chromatographic characterization of proteins in mucous and serous middle ear effusions of patients with otitis media in comparison to serum proteins

Otitis media with effusion (OME) is an inflammatory disease of the middle ear cavity that is associated with middle ear effusions (MEEs), which are frequently mucous and serous for pediatric and adult patients exhibiting low and high responsiveness to medical treatment, respectively. To assess the pathological outcomes in mucous and serous MEEs, their protein compositions were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting in comparison with those in the same patients' sera. A mucin, which is immunochemically identical with nasal mucin, was a characteristic consituent of mucous MEEs (n = 25), being present at the concentration of 59.4 mg/ml and comprising about 60% of the total proteins, but it was not detected in serous MEEs (n = 30) or sera. Serum proteins with molecular weights of less than 260 kDa were detected in serous and mucous MEEs, in which albumin was the major protein. Albumin, IgM and alpha1-acid glycoprotein, and lysozyme, IgA and IgG in MEEs were present at lower and higher concentrations than in sera, respectively. The ratios of IgA, IgG, IgM and alpha1-acid glycoprotein to albumin in mucous MEEs were 4-, 3-, 1.4- and 1.0-times higher than those in the respective pediatric sera, and those in serous MEEs were 1.7-, 1.7-, 0.6- and 0.3-times higher than those in adult sera. Also, the concentrations of lysozyme in mucous and serous MEEs were 19 and 3 microg/ml, but those in pediatric and adult sera were negligible. These results indicate that the contents of these proteins, in comparison to albumin, might be useful criteria for assessing the inflammation level in MEEs.

Detection of Helicobacter pylori in Children with Otitis Media with Effusion: A Preliminary Report

To determine the presence of Helicobacter pylori in the middle ear effusion of patients with otitis media with effusion (OME) by polymerase chain reaction (PCR). A prospective study in patients with OME. The study was performed in 38 patients with OME who were admitted to the ENT Clinic, Firat University from June 2003 to April 2004. In all cases, a myringotomy operation (with or without placement of a ventilation tube) was carried out. The effusion samples aspirated from the middle ear were analyzed with PCR assay. A total of 55 aspiration samples collected from 38 children ranging in age from 2 to 12 were included in the study. Fifteen of the subjects were girls, and 23 were boys. In 17 patients, both ears demonstrated effusions, whereas in 21 patients, only one ear had effusions. Nine (16.3%) of 55 the middle ear effusion samples were shown to be H. pylori positive by PCR. H. pylori was detected in the middle ear effusion of some patients with OME. These results may have interesting implications for a possible role of H. pylori in OME. In addition, these results suggest that further studies are needed to investigate the role of H. pylori in the etiology of OME.

Identification, Distribution, and Expression of Novel Genes in 10 Clinical Isolates of Nontypeable Haemophilus influenzae

We hypothesize that Haemophilus influenzae, as a species, possesses a much greater number of genes than that found in any single H. influenzae genome. This supragenome is distributed throughout naturally occurring infectious populations, and new strains arise through autocompetence and autotransformation systems. The effect is that H. influenzae populations can readily adapt to environmental stressors. The supragenome hypothesis predicts that significant differences exist between and among the genomes of individual infectious strains of nontypeable H. influenzae (NTHi). To test this prediction, we obtained 10 low-passage NTHi clinical isolates from the middle ear effusions of patients with chronic otitis media. DNA sequencing was performed with 771 clones chosen at random from a pooled genomic library. Homology searching demonstrated that approximately 10% of these clones were novel compared to the H. influenzae Rd KW20 genome, and most of them did not match any DNA sequence in GenBank. Amino acid homology searches using hypothetical translations of the open reading frames revealed homologies to a variety of proteins, including bacterial virulence factors not previously identified in the NTHi isolates. The distribution and expression of 53 of these genes among the 10 strains were determined by PCR- and reverse transcription PCR-based analyses. These unique genes were nonuniformly distributed among the 10 isolates, and transcription of these genes in planktonic cultures was detected in 50% (177 of 352) of the occurrences. All of the novel sequences were transcribed in one or more of the NTHi isolates. Seventeen percent (9 of 53) of the novel genes were identified in all 10 NTHi strains, with each of the remaining 44 being present in only a subset of the strains. These genic distribution analyses were more effective as a strain discrimination tool than either multilocus sequence typing or 23S ribosomal gene typing methods.

Similar allergic inflammation in the middle ear and the upper airway: Evidence linking otitis media with effusion to the united airways concept

Otitis media with effusion (OME) is a chronic inflammatory disease of the middle ear space characterized by the accumulation of fluid. Previous investigations have suggested that the immunopathologic mechanism underlying the development of middle ear effusion in patients with allergy is largely due to the effects of T(H)2 mediators. The composition of the inflammatory substrate in the effusions of allergic otitis media is similar to the late-phase allergic response seen elsewhere in the respiratory tract, such as in asthma and in allergic rhinitis. To determine whether the middle ear compartment may be a component of the united airways in allergic disease by comparing the inflammatory profiles of the middle ear to the upper airway. Middle ear effusions, torus tubaris (Eustachian tube mucosa at the nasopharyngeal orifice), and adenoidal tissue biopsies were obtained from 45 patients undergoing simultaneous tympanostomy tube placement for OME and adenoidectomy for adenoid hypertrophy. The cellular and cytokine profiles of each site were investigated by using immunocytochemistry (elastase, CD3, major basic protein) and in situ hybridization (IL-4, IL-5, IFN-gamma mRNA). Atopic status was determined for each patient by using skin prick testing. Eleven of the 45 patients with OME (24%) were atopic. The middle ear effusions of atopic patients had significantly higher levels of eosinophils, T lymphocytes, and IL-4 mRNA + cells ( P < .01) and significantly lower levels of neutrophils and IFN-gamma mRNA + cells ( P < .01) compared with nonatopic patients. The nasopharyngeal tissue biopsies revealed similar cellular and cytokine profiles. In atopic patients with OME, the allergic inflammation occurs on both sides of the Eustachian tube, both in the middle ear and in the nasopharynx. The results of this study support the concept that the middle ear may be part of the united airway in atopic individuals.

Detection of LMP-1 gene in middle ear effusion of NPC

Nasopharyngeal carcinoma (NPC) is closely related with Epstein–Barr virus (EBV). Almost every NPC tumor cells carries clonal EBV genomes. Detection of EBV derived latent membrane protein-1 gene (LMP-1) indicate the presence of NPC. Middle ear effusion (MEE) is a frequent sign of NPC. There have been no reports on LMP-1 in MEE. Tympanocentesis of 88 ears with MEE of 66 patients were done in three groups of patients, group (I) NPC, 31 patients, 50 ears, (II) other head and neck cancers, five patients, six ears and (III) no cancer history, 30 patients, 32 ears. The middle ear aspirate and nasopharyngeal swab specimen were collected to detect LMP-1 with a PCR-based method. Sixty aspirates (68%) out of 88 ears with MEE had enough DNA for PCR amplification. LMP-1 was detected in six middle ear aspirate specimen from three patients in group I who had petrous apex invasion. LMP-1 was detected in 30 swab specimen (93.8%) out of 32 nasopharyngeal swabs in group I. LMP-1 was not detected in middle ear aspirates or nasopharyngeal swab in group II and III patients. LMP-1 was not detected in MEE in patients without NPC. In NPC patients, the detection of LMP-1 may indicate petrous apex invasion.