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07-04-2013 | General practice | Article

Minimal role of sterile inflammation in otitis media


Free abstract

medwireNews: Research reveals no significant microbial differences between samples taken from children with recurrent acute otitis media (rAOM) or chronic otitis media with effusion (COME).

"Based on these results, we propose that the common perception that rAOM is associated with recurrent episodes of microbiologically mediated AOM, whereas COME is generally a sterile inflammation, should be reconsidered," say Peter Hermans (Radboud University Medical Centre, Nijmegen, the Netherlands) and colleagues.

As reported in the International Journal of Pediatric Otorhinolaryngology, the researchers enrolled 174 children aged 5 years or below who were scheduled to have tympanostomy tube insertion between 2008 and 2009. Of these, 45 had rAOM and 129 had COME.

The researchers collected middle ear (n=119) and nasopharyngeal samples (n=173) from the participants to test for Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis, as well as for 15 respiratory viruses.

The team found no significant difference in the occurrence of bacterial and viral middle ear pathogens in patients with rAOM versus COME. The most commonly detected virus and bacterium were rhinovirus and H. influenza. The latter was found in 24-42% versus 19-32% of middle ear samples taken from patients with rAOM and COME, respectively, depending on whether bacterial culture or polymerase chain reaction tests were used. Similarly, H. influenza was found in a respective 68% and 70% of rAOM and COME nasopharyngeal samples.

Additionally, although they were found less often, the frequency of S. pneumoniae and M. catarrhalis did not differ between children with rAOM and COME.

"Our results show that the same pathogenic bacterial species and viruses are implicated in the pathogenesis of both rAOM and COME disease," write the authors.

"Further, our findings do not support the general assumption that the microbial profile is pathognomonic for either rAOM or COME, or that COME is merely a consequence of persistent sterile inflammation in the middle ear," they conclude.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Helen Albert, Senior medwireNews Reporter

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