The Pediatric Infectious Disease Journal. 31(11):1128–1134, NOVEMBER 2012
DOI: 10.1097/INF.0b013e3182611d6b
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PMID: 22668804
Issn Print: 0891-3668
Publication Date: November 2012
Inflammation in the Middle Ear of Children With Recurrent or Chronic Otitis Media Is Associated With Bacterial Load
Kim Stol;Dimitri Diavatopoulos;Kees Graamans;Joost A. Engel;Willem J. Melchers;Huub F. Savelkoul;John Hays;Adilia Warris;Peter W. Hermans;
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From the Departments of *Pediatrics and †Otorhinolaryngology, Radboud University, Nijmegen Medical Centre; ‡Department of Otorhinolaryngology, Canisius-Wilhelmina Hospital; §Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen; ¶Cell Biology and Immunology Group, Wageningen University, Wageningen; and ‖Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands.
Abstract
Viral upper respiratory tract infections have been described as an important factor in the development of otitis media (OM), although it is unclear whether they facilitate bacterial OM or can directly cause OM. To clarify the role of viral infections in OM, we compared the relative contribution of viruses and bacteria with the induction of inflammatory cytokine responses in the middle ear of children suffering from OM.Children up to 5 years of age, with recurrent or chronic episodes of OM and scheduled for ventilation tube insertion were enrolled in a prospective study. Middle ear fluids (n = 116) were collected during surgery, and quantitative polymerase chain reaction was performed to detect bacterial and viral otopathogens, that is, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and 15 respiratory viruses. Finally, concentrations of the inflammatory mediators interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17a and tumor necrosis factor-α were determined.Middle ear fluids were clustered into 4 groups, based on the detection of viruses (28%), bacteria (27%), both bacteria and viruses (27%) or no otopathogens (19%). Bacterial detection was associated with significantly elevated concentrations of cytokines compared with middle ear fluids without bacteria (P < 0.001 for all cytokines tested) in a bacterial load-dependent and species-dependent manner. In contrast, the presence of viruses was not associated with changes in cytokine values, and no synergistic effect between viral-bacterial coinfections was observed.The presence of bacteria, but not viruses, is associated with an increased inflammatory response in the middle ear of children with recurrent or chronic OM.
