Pathogenesis Of Otitis Media With Effusion Research Articles

Surfactant Protein A Can Affect Macrophage Phagocytosis: An Important Pathogenic Mechanism of Otitis Media with Effusion.

Otitis media with effusion (OME), also known as secretory otitis media, is a common condition in otorhinolaryngology. The main manifestations include middle ear effusion and conductive hearing loss. Recently, increasing attention has been paid to the etiology of OME, wherein immune dysfunction is one important pathogenic mechanism. However, it is unknown whether changes in surfactant protein A (SPA) secretion affect the phagocytic activity of macrophages in the Eustachian tube, thereby altering pathogen clearance, during the pathogenesis of OME. In our study, an OME animal model was established and evaluated. Differences in SPA levels in Eustachian tube lavage fluid between the experimental and control groups were analyzed. Cell-based experiments revealed that SPA decreased the expression of CD64 and SYK and inhibited phagocytosis by RAW264.7 cells. By using flow cytometry and immunofluorescence, we confirmed that macrophage phagocytosis decreased with increasing SPA levels. Finally, we concluded that SPA affects macrophage function and plays a role in the occurrence and development of OME.

Advances in the role of adenoid hypertrophy in the pathogenesis of otitis media with effusion in children

Adenoid hypertrophy(AH) and otitis media with effusion (OME) are both common diseases in pediatric otorhinolaryngology and are often associated with each other. Children are often diagnosed with otitis media with effusion and adenoid hypertrophy(OME/AH). Adenoids are immune lymphoid tissues of children's upper respiratory tract, and are important barriers against upper respiratory tract infections.During an upper respiratory tract infection,bacteria or viruses repeatedly stimulate immune lymphoid tissue to cause hyperplasia,and pathological hypertrophy is often accompanied by OME and other related symptoms.In recurrent or chronic OME, hyperproliferative adenoids are usually excised indicating that the two diseases may have a certain correlation. Recently,more and more studies have shown that AH plays an important role in the pathogenesis of OME in children. This article elucidates the role of AH in the pathogenesis of childhood OME from adenoid mechanical obstruction,adenoid bacterial and bacterial biofilm, adenoid local immune regulation, and IgE-mediated allergic reaction.

Combined multichannel intraluminal impedance-pH monitoring should be used to diagnose reflux-related otitis media with effusion in children.

This study investigated the diagnostic usefulness of combined multichannel intraluminal impedance-pH monitoring (MII-pH) in children with suspected reflux-related otitis media with effusion (OME) as existing data were scarce. This was a prospective study that included children up to seven years of age who underwent MII-pH due to OME lasting more than three months. The study was conducted in the Children's Hospital Zagreb, Croatia, from January 2014 to August 2016. The study comprised 63 children (63% male) with a mean age of 4.7years. Gastroesophageal reflux (GER) disease was detected by impedance in 22 (35%) of the children and by pH-metry in nine (14%). In children with OME, MII-pH found a median number of 24 proximal GER episodes, of which a median of nine was acidic and a median of 11 was weakly acidic. There was a significant positive correlation between the number of GER episodes and the presence of eosinophils in nasal swabs. Both acidic and weakly acidic refluxes seemed to play a significant role in the pathogenesis of OME. Localised nasal eosinophilia may serve as a marker of extraoesophageal reflux in children with suspected reflux-related OME.

Study of Helicobacter pylori in Middle Ear Effusion in Children

Introduction: Otitis media is one of the most common diseases in children. It is believed that gastroesophageal reflux disease (GERD) is a predisposing factor in most upper respiratory tract problems including pharyngoesophagitis, croup, oropharyngeal adenophagia, rhinosinusitis, and otitis media. The probable role of H.pylori in otitis media with effusion (OME) was investigated in this study. Methods: Fresh stool specimens and serum samples from 40 children with OME were analyzed with antigen in stool and antibody in serum. The effusion samples were taken and analyzed using rapid urease test (RUT) and Polymerase Chain Reaction (PCR). Results: RUT was positive in 13 (32.5%) patients and PCR was positive in 15 (37.5%) patients. Ag in stool was positive in 27 (67.5%) and Ab in serum was positive 21 (52.5%). Conclusion: The presence of H.pylori in the middle ear effusion and stool indicates that this bacterium might be involved in the pathogenesis of OME.

Pro-inflammatory interleukins in middle ear effusions from atopic and non-atopic children with chronic otitis media with effusion.

Chronic otitis media with effusion (OME) is associated with irreversible changes in the middle ear, sometimes leading to hearing loss and abnormal language development in children. While the pathogenesis of OME is not fully understood, inflammatory and allergic factors are thought to be involved. The study aimed to investigate the role of cytokines in the local development of chronic OME, and assess differences in the cytokine profiles between atopic and non-atopic children. 84 atopic and non-atopic children with chronic OME (mean age of 6years 7months) were studied. Age-matched children with hypertrophy of the adenoids and Eustachian tube dysfunction served as the control group. The number of past acute otitis media (AOM) episodes, their age, and the type of effusion were recorded for all children. Pro-inflammatory cytokine concentrations (TNF-α, IL-1β, IL-6 and IL-8) were determined and the presence of pathogenic bacteria in the patients' effusions was examined. High concentrations of TNF-α, IL-1β, IL-6 and IL-8 were found in the effusions in all children with chronic OME, with the highest levels observed in the non-atopic group. The atopic group showed persistently high IL-1β levels, while in the non-atopic children, IL-1β and TNF-α levels positively correlated with the patient's age and the number of past AOM episodes. Pathogenic bacteria were more frequently isolated from effusions in non-atopic children. In both atopic and non-atopic children, pro-inflammatory cytokines are found at high concentrations. This argues in favor of instituting anti-inflammatory management for treating OME, regardless of atopy.

Role of pepsin and pepsinogen: Linking laryngopharyngeal reflux with otitis media with effusion in children

To analyze the relationship between laryngopharyngeal reflux (LPR) represented by pepsin and pepsinogen, and pathogenesis of otitis media with effusion (OME). Prospective case-control study. Children with OME who required adenoidectomy and tympanostomy/tympanostomy tubes placement were enrolled in OME group, whereas children with adenoid hypertrophy (AH) who required adenoidectomy and individuals who required cochlear implantation (CI) were enrolled in AH and CI groups, respectively. Pepsinogen mRNA and protein levels were assessed by real-time fluorescence-based quantitative polymerase chain reaction and immunohistochemistry in adenoid specimens from the OME and AH groups. Pepsin and pepsinogen concentrations were evaluated by enzyme-linked immunosorbent assay in middle ear fluid and plasma from the OME and CI groups. The levels of pepsinogen protein expressed in cytoplasm of epithelial cells and clearance under epithelial cells in adenoid specimens from the OME group were significantly higher than those in the AH group. Furthermore, the concentrations of pepsin and pepsinogen in the OME group were 51.93±11.58 ng/mL and 728±342.6 ng/mL, respectively, which were significantly higher than those in the CI group (P<.001). In addition, the concentrations of pepsin in dry ears were significantly lower than those in serous and mucus ears in the OME group (F=22.77, P<.001).Finally, the concentration of pepsinogen in middle ear effusion was positively correlated with the expression intensity of pepsinogen protein in cytoplasm of epithelial cells (r=0.73, P<.05) in the OME group. Pepsin and pepsinogen in middle ear effusion are probably caused by LPR and may be involved in the pathogenesis of OME. 3b.

C-type lectin receptors mRNA expression in patients with otitis media with effusion

ObjectiveThe role of C-type lectin receptor, a type of pattern recognition receptor, in otitis media with effusion (OME) is unclear. We assayed the levels of expression of C-type lectin receptor mRNA in children with OME and evaluated its relationship to the presence of bacteria, accompanying diseases, and characteristics of exudates. Subjects and MethodsThe study population consisted of 73 children with OME who had undergone ventilating tube insertion. The levels of expression of Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, Dec-205, Galectin-1, Tim-3, Trem-1, and DAP-12 mRNA in middle ear effusion were determined by real-time PCR. The level of expression of each mRNA was correlated with the presence of bacteria, accompanying diseases, and exudates characteristics. ResultsThe levels of expression of C-type lectin receptor mRNAs were not associated with bacterial presence or exudates characteristics (p>0.05 each). Levels of expression, however, were significantly higher in patients with sinusitis, adenoid vegetation or adenoiditis, and allergic rhinitis (p<0.05 each). ConclusionsLevels of expression of C-type lectin receptor mRNA may be associated with the pathogenesis of OME, being significantly higher in patients with than without accompanying sinusitis, adenoid vegetation or adenoiditis, and allergic rhinitis.

English

The significant incidence of atopy associated with otitis media with effusion (OME) has suggested a role of allergy in the pathogenesis of OME. Past studies implicated allergy in the pathogenesis of otitis media (OM). Otitis media is a common condition, especially in children. Most episodes of OM were associated with an upper respiratory viral infection and are short- lived and self-limiting with or without medical treatment. However, chronic OM with effusion (OME) has significant sequelae, is refractory to most medical treatments, and frequently requires surgical intervention. A large body of epidemiologic and mechanistic evidence supports a role for allergic rhinitis (AR) as a risk for OM. To establish the association of allergic rhinitis with otitis media with effusion 100 children of age group 5 to14 were taken, 50 children were suffering from otitis media(test group) & 50 were healthy(control group). These children were evaluated clinically & a battery of laboratory tests was performed in all children to establish the prevalence of allergic rhinitis in them. Out of 50 children with otitis media 12 were suffering from allergic rhinitis & out of 50 healthy children 3 were suffering from allergic rhinitis. Chi-square test was performed and the 'P0.05' value was found to be 0.0127(uncorrected) and was highly significant. These findings indicate that prevalence of allergic rhinitis is more in persons suffering from OME as compared to healthy individuals.

Incidence of Helicobacter pylori infection and their clarithromycin-resistant strains in otitis media with effusion regarding phenotypic and genotypic studies

Helicobacter pylori (H. pylori) are pathogenic bacteria that infect a half of the human population, colonize gastric mucosa and can be found in gastric juice. Reflux of gastric juice has been suggested to be associated with glue ear in children. It has been suggested that tonsil and adenoid tissues are potential reservoirs of H. pylori infection. These observations raise the question as to whether H. pylori infection might have a role in otitis media with effusion (OME) in children. The objectives of this research were to evaluate the incidence and possible role of H. pylori in the pathogenesis of OME in children and to evaluate the clarithromycin-resistant strains. Molecular assessment was done to evaluate the culture results vs. molecular study. A total of 60 children, who were prone to ventilation tube insertion, adenoidectomy and/or tonsillectomy were included in the study. The control group consisted of 40 children who underwent adenoidectomy and/or tonsillectomy without the history of OME. Samples of the middle ear fluid and mucosa, adenoid tissue, tonsillar tissue and gastric lavage were cultured and underwent polymerase chain reaction (PCR) analysis then were assembled by using QIAxcel System as capillary electrophoresis for H. pylori detection. There was significant difference between the results of cultures and PCR (P<0.05). Middle ear fluid culture was positive for H. pylori in 40% of the patients vs. 56.7% PCR results while middle ear mucosa culture was positive in 20% vs. 26.7% PCR results. Gastric lavage culture was positive in 46.6% of the patients and PCR was positive in 63.3% of the patients. Adenoid culture and PCR were positive in 56.3% for each, while tonsil culture was positive in 70% and PCR was positive in 90%. H. pylori presence in the gastric lavage, the tonsillar and adenoid tissues by culture and PCR was significantly more frequent in the study group compared to the control group. The minimum inhibitory concentration (MIC) values of clarithromycin-resistant isolates ranged from 1.5 to 8μg/ml. This study showed the presence of H. pylori in around 50% of the patients with OME. PCR revealed its sensitivity than culture techniques. The incidence of clarithromycin resistance was found to be high among the isolates (39.6%).

The role of vascular endothelial growth factor in pediatric otitis media with effusion

Objectives Vascular endothelial growth factor (VEGF) is a potent and critical inducer of angiogenesis and vascular permeability, and has been shown to play an important role in inflammatory events, together with hypoxia and inflammatory cytokines. VEGF messenger ribonucleic acid (mRNA) is expressed in the middle ear in an experimental animal model of otitis media with effusion (OME) and in patients with OME. However, the protein levels of VEGF in middle ear effusions (MEEs) are unknown and the role of VEGF in the pathogenesis of OME is unclear. The goals of this study were to determine the VEGF levels in MEEs and to investigate the role of VEGF in production of MEEs by comparing these levels with those of interleukin-8 (IL-8), endotoxin, and albumin. Methods Forty-six MEEs obtained from 33 children (24 boys, 9 girls) were used in the study. The mean age of the subjects was 6.3 years old (range, 1–12 years old). The patients underwent myringotomy and/or insertion of a ventilation tube for treatment of OME. After myringotomy, MEEs were collected with a Juhn Tym-Tap. The samples were divided into serous and mucoid types based on observation by the naked eye. After measuring the weight of the MEE, the sample was diluted with phosphate-buffered saline and frozen until use. The concentrations of VEGF and IL-8 in the MEEs were determined by enzyme-linked immunosorbent assays, endotoxin concentrations were measured by the Limulus Amebocyte Lysate test, and albumin levels were determined using an immunoturbidimetric assay. Results VEGF, endotoxin, IL-8, and albumin were detected in 100%, 89%, 98%, and 100% of the 46 MEEs, respectively. The concentrations of VEGF, endotoxin, and IL-8 were significantly higher in mucoid MEEs than in serous MEEs ( p < 0.01), whereas there was no significant difference in the albumin concentration between mucoid and serous MEEs. The VEGF levels were positively correlated with those of endotoxin ( R 2 = 0.17, p < 0.05) and albumin ( R 2 = 0.65, p < 0.01) in mucoid MEEs, but not in serous MEEs. Conclusions Our results suggest that VEGF is produced in response to bacterial components such as endotoxin in the middle ear cavity and is associated with production of mucoid MEEs by increasing serum exudation and mucosal secretion.

The role of atopy in otitis media with effusion among primary school children: audiological investigation

The objective of this study was to evaluate the role of atopy in otitis media with effusion (OME) in children attending primary school in western Sicily focusing on the audiological characteristics among atopic and non-atopic subjects suffering from OME. A total of 310 children (5-6 years old) were screened by skin tests and divided into atopics (G1) and non-atopics (G2). The samples were evaluated for OME by pneumatic otoscopy, tympanogram and acoustic reflex tests. The parameters considered were: documented persistent middle ear effusion by otoscopic examination for a minimum of 3 months; presence of B or C tympanogram; absence of ipsilateral acoustic reflex and a conductive hearing loss greater than 25 dB at any one of the frequencies from 250 Hz through 4 kHz. A total of 56 children (18.06%) resulted to be atopics while 254 were non-atopics. OME was identified in 24 atopic children and in 16 non-atopic children for a total number of 40 children; the overall prevalence rate was 12.9% (42.85% for G1 and 6.30% for G2). OME was bilateral in 28 children (70%), with a significative difference between G1 (79.17%) and G2 (56.25%). The prevalence of B tympanogram was 70.59%, corresponding to 79.07% for G1 and 56% for G2. The mean air conduction pure tone was, respectively, 31.97 dB for G1 and 29.8 dB for G2. The prevalence value of OME in atopic children, also supported by the higher predominance of bilaterality, B tympanogram and hearing loss among this group, could suggest the important role of allergy in the pathogenesis of OME.

The role of adenoidal obstruction in the pathogenesis of Otitis media with effusion in Nigerian children

Although adenoidectomy is generally applied in the treatment of otitis media with effusion (OME), there is still much debate about the role of adenoid in the pathogenesis of OME. The purpose of this study is to determine the incidence of OME in children with obstructive adenoid disease in comparison with normal control, and the degree of nasopharyngeal obstruction by adenoid as it relates to the development of OME in Nigerian children. Controlled, prospective clinical study was carried out. Diagnosis of OME was made with finding of type B tympanogram on tympanometry evaluation. The incidence of OME among adenoidal patients was compared with its incidence in normal control. The degree of nasopharyngeal obstruction among the adenoidal subjects was evaluated with an adenoidal-nasopharyngeal ratio parameter obtained from soft tissue radiograph of nasopharynx, and was related to the results of tympanometric evaluation of the adenoidal subjects. The incidence of OME was significantly higher in the adenoidal children than the normal control (p < 0.001). The risk of OME was more than 7 times as more among adenoidal group than among the non-adenoidal control. Gross nasopharyngeal obstruction was significantly associated with type B tympanogram (p = 0.002). The diagnosis of OME correlated significantly with the degree of nasopharyngeal obstruction (r = 0.32; p = 0.002). Our study found adenoid obstruction as a significant risk factor for OME in children. The risk of OME increases with the increasing degree of nasopharyngeal obstruction.

The prevalence of atopic symptoms in children with otitis media with effusion

Objective To determine the prevalence of allergic symptoms in children with otitis media with effusion (OME). Study Design A validated questionnaire from the International Study of Asthma and Allergies in Childhood was used to determine the prevalence of allergic symptoms in children. The questionnaire was completed by the parents of children with OME undergoing ventilation tube insertion, and the results were compared with a large reference group of school children of the same age. Subjects and Methods Children aged 6 or 7 years old with OME confirmed intraoperatively during ventilation tube insertion between 2001 and 2005 (n = 89). The prevalence of allergic symptoms and nasal symptoms in children with OME was compared with an age-matched reference group. Results There was no difference in the prevalence of allergic symptoms suggesting rhinoconjunctivitis, asthma, or eczema between the OME and reference group. The prevalence of nasal symptoms, however, was greater in the children with OME than in the reference group 38.2 percent versus 23.5 percent (odds ratio = 2.01; 95% confidence interval, 1.30-3.10; P < 0.001). Conclusion The prevalence of allergic symptoms was similar in 6- to 7-year-old children with OME and the reference group, suggesting a limited effect of allergy in the pathogenesis of OME in this age group. Nasal symptoms were more common in the OME group, which may reflect a higher prevalence of adenoidal hyperplasia.

Biofilms and chronic otitis media: an initial exploration into the role of biofilms in the pathogenesis of chronic otitis media

Purpose The aim of the study was to compare the extent of biofilm infection in percentage of mucosal surface area of adenoids removed from children with otitis media with effusion (OME) vs those with recurrent acute otitis media (RAOM) and obstructive sleep apnea (OSA). Materials and methods Comparative microanatomical investigation of adenoid mucosa using scanning electron microscopy obtained from 30 children with OME, RAOM, and OSA was used in this study. Seventeen males and 13 females ranging in age from 9 months to 10 years were included in this study. Percentage of biofilm surface area involvement was the main measure. Results Adenoids removed from patients with OME had moderately dense mature biofilms covering the mucosal surface with a mean of 27.7% of their mucosal surface covered with mature biofilms. These results were distinct from results obtained from patients diagnosed with RAOM and OSA with means of 97.6% and 0.10% of their mucosal surfaces covered with mature biofilms, respectively. These differences were statistically significant at P < .0001. Conclusions Adenoids removed from patients with OME were characterized by distinctly different percentage of biofilm mucosal surface area coverage, with significantly more biofilm presence than OSA patients but significantly less biofilm presence than RAOM patients. Although previous investigations have supported a dominant role of nasopharyngeal biofilms in RAOM pathogenesis, these results suggest nasopharyngeal biofilms may play a different role in the pathogenesis of OME and that this clinical entity may be more multifactorial in nature.

Prognostic impact of phosphorylcholine expression in nontypeable Haemophilus influenzae in otitis media with effusion

Conclusions: The expression of phosphorylcholine (ChoP) in the surface of nontypeable Haemophilus influenzae (NTHi) is an important factor in the pathogenesis of persistent otitis media with effusion (OME) in humans. Objectives: Lipooligosaccharide (LOS) in NTHi undergoes phase variation in expression of the ChoP epitope. In this study, we examined the phase variation of NTHi isolated from the nasopharynx of children who suffer from OME, and investigated the relationship between the phase variation and the pathogenesis of OME. Subjects and methods: Forty NTHi strains were isolated from the nasopharynx of children with OME, and the ChoP expression of NTHi was examined by colony immunoblot analysis. The NTHi strains were classified into three groups according to the level of ChoP expression, i.e. strong, moderate, and weak expression groups. An adherence assay was also performed. Results: The NTHi strains expressing ChoP+ LOS glycoforms accounted for 63% of all NTHi tested. Clinically, the strong expression group of ChoP were related to prolongation of the duration of OME. The adherence assay with the CCL 20.2 cell line revealed that the strong expression group attached more easily to the cell surface than the weak expression group.

Serous Otitis Media in Children

Otitis media with effusion (OME) has long been considered to be a noninfective disease resulting from a eustachian tube dysfunction. However, several microbiological techniques have shown bacteria in the middle ear fluids from patients with OME. Alloiococcus otitidis has been detected in the middle ear fluid from patients with OME. The exact role of this infectious agent in the pathogenesis of OME has yet to be elucidated. A prospective clinical trial. A tertiary university-based referral center. The inclusion criteria included 110 patients aged between 1 and 12 years. The control group included samples obtained from 30 healthy children undergoing a cochlear implantation. The second group included 40 middle ear effusions (MEEs) that were collected from 40 pediatric OME patients during the placement of the ventilation tube. As for the third group, they were 40 children with acute otitis media. The bacterial analysis of the MEE was performed by means of microbiological culture-specific techniques. Positive cultures for A. otitidis as analyzed by bacteriological analysis of samples from the middle ear mucosa and MEE. Bacteria were present in the culture of 72.5% (29) of the patients with OME. Alloiococcus otitidis was the most frequent bacterium in OME (48.27%) as well as Haemophilus influenzae nonserotype B (17.24%). Streptococcus pneumoniae was the most commonly detected pathogen in acute otitis media (37.5%), and then H. influenzae nonserotype B (25%). For most of the OME cases, only A. otitidis bacteria were isolated. We observed a high rate of culture positivity for A. otitidis in patients with clinical OME without suppuration. Further studies are needed to confirm whether the association of A. otitidis with OME represents causality. Antibiotic therapy aimed at A. otitidis is complicated by reported resistance, thus emphasizing the importance of our understanding of the pathogenetic role played by this organism

Presence of herpesviruses in middle ear fluid of children with otitis media with effusion

Otitis media with effusion (OME) is a disease that frequently occurs in children. Etiopathogenesis of the diseases has not been completely elucidated. There are limited numbers of studies on the presence of herpesviruses in otitis media cases with OME. The present study was undertaken to determine the rate of some herpesviruses in OME cases of children. A total of 92-middle ear fluids were collected from 51 children. The samples were analyzed using polymerase chain reaction (PCR) for detection of herpesviruses including Herpes simplex virus (HSV), cytomegalovirus (CMV), Varicella zoster virus (VZV), and Epstein-Barr virus (EBV). PCR analysis of the 92 samples showed that genomes of EBV in 12 (13.04%), HSV in seven (7.60%), CMV in five (5.43%), and VZV in three (3.26%) were present. Two of these samples were positive for both HSV and EBV genomes. Therefore, 25 (27.17%) of the samples were determined to be infected with any of the herpesviruses tested. In the present study, herpesviruses were determined at a high rate in middle ear fluids of children with OME. However, the present study is a preliminary study and more extensive studies, especially experimental studies, are required to elucidate the role of herpesviruses in pathogenesis of OME and whether there is a relation between rate of herpesviruses in OME cases, and the reactivation of latent infections.

Interleukin‐1β upregulates Na+‐K+‐2Cl− cotransporter in human middle ear epithelia*

Disruption of periciliary fluid homeostasis is the main pathogenesis of otitis media with effusion (OME), one of the most common childhood diseases. Although the underlying molecular mechanisms are unclear, it has been suggested that the altered functions of ion channels and transporters are involved in the fluid collection of middle ear cavity of OME patients. In the present study, we analyzed the effects of a major cytokine interleukin (IL)-1beta, which was known to be involved in the pathogenesis of OME, on Na(+)-K(+)-2Cl(-) cotransporter (NKCC) in human middle ear cells. Intracellular pH (pH(i)) was measured in primary cultures of normal human middle ear epithelial (NHMEE) cells using a double perfusion chamber, which enabled us to analyze the membrane-specific transporter activities. NKCC activities were estimated by the pH(i) reduction due to bumetanide-sensitive intracellular uptake of NH(4) (+). In NHMEE cells, NKCC activities were observed only in the basolateral membrane, and immunoblotting using specific antibodies revealed the expression of NKCC1. Interestingly, IL-1beta treatments augmented the basolateral NKCC activities and increased NKCC1 expression. In addition, IL-1beta treatments stimulated bumetanide-sensitive fluid transport across the NHMEE cell monolayers. Furthermore, an elevated NKCC1 expression was observed in middle ear cells from OME patients when compared to those from control individuals. The above results provide in vitro and in vivo evidence that the inflammatory cytokine IL-1beta upregulates NKCC1 in middle ear epithelial cells, which would be one of the important underlying mechanisms of excess fluid collection in OME patients.

Helicobacter pylori: A possible association with otitis media with effusion

Evaluate possible role of Helicobacter Pylori in pathogenesis of otitis media with effusion (OME). Randomized controlled trial, tertiary referral center. Middle ear fluid was aspirated, a biopsy was taken from the promontorium of 22 children with OME. A small biopsy was taken from the promontorium of 20 children with normal otologic findings. For both groups, 5 mm deep tissue specimens were obtained from tonsil and adenoid. H pylori presence in the middle ear, the tonsillar and adenoid tissues by culture and PCR was significantly more frequent in the study group compared to the control group (P<0.05). This study is the first to grow H pylori in middle ear in OME. Significantly increased colonization by H pylori of the middle ear, and tonsillar and adenoid tissue in patients with OME indicates that the bacteria might be involved in the pathogenesis of OME. A-1b.

The role of allergic rhinitis in upper respiratory tract inflammatory diseases

SummaryThe number of patients with allergic rhinitis (AR) is increasing. Furthermore, patients with otitis media with effusion (OME) and chronic sinusitis (CS) are frequently complicated with AR. These findings suggest that AR has an impact on the pathogenesis of both OME and CS. The direct and indirect influence of AR on OME and CS was investigated by clinical and experimental studies to clarify the mechanism by which type I allergic reaction is associated with OME and CS. Clinical findings of patients with OME or CS complicated with AR were analysed and compared with those of nonallergic subjects. Samples such as sinus effusions and middle ear effusions (MEE) were collected from the patients and infiltration of inflammatory cells and concentrations of inflammatory cytokines determined. In addition, previous reports discussing the relationship between AR and OME or CS are reviewed. Eosinophil infiltration and oedema were remarkable in paranasal sinus mucosa of patients with CS complicated with AR, suggesting the presence of type I allergic reaction in sinus mucosa. However, there was little evidence of eosinophils in sinus effusions. Endotoxin was frequently detected in sinus effusions of patients with CS having AR as well as suppurative CS. Hypoxia was also considered an important factor inducing sinus pathology. Eosinophils and IgE antibodies in MEE were not increased in OME patients with AR. Anti‐allergic medicine was effective in OME patients complicated with AR and improvement of nasal symptoms significantly correlated with that of ear symptoms. AR might be directly and indirectly associated with the pathogenesis of OME and CS.