Date Published: February 23, 2017
Publisher: Public Library of Science
Author(s): G. P. Buzatto, E. Tamashiro, J. L. Proenca-Modena, T. H. Saturno, M. C. Prates, T. B. Gagliardi, L. R. Carenzi, E. T. Massuda, M. A. Hyppolito, F. C. P. Valera, E. Arruda, W. T. Anselmo-Lima, R. Mark Wooten.
To evaluate the presence of viruses and bacteria in middle ear and adenoids of patients with and without otitis media with effusion (OME).
Adenoid samples and middle ear washes (MEW) were obtained from children with OME associated with adenoid hypertrophy undergoing adenoidectomy and tympanostomy, and compared to those obtained from patients undergoing cochlear implant surgery, as a control group. Specific DNA or RNA of 9 respiratory viruses (rhinovirus, influenza virus, picornavirus, syncytial respiratory virus, metapneumovirus, coronavirus, enterovirus, adenovirus and bocavirus) and 5 bacteria (S. pneumoniae, H. influenzae, M. catarrhalis, P. aeruginosa and S. aureus) were extracted and quantified by real-time PCR.
37 OME and 14 cochlear implant children were included in the study. At the adenoid, virus and bacteria were similarly detected in both OME and control patients. At the middle ear washes, however, a higher prevalence of bacteria was observed in patients with OME (p = 0.01). S. pneumoniae (p = 0.01) and M. catarrhalis (p = 0.022) were the bacteria responsible for this difference. Although total virus detection was not statistically different from controls at the middle ear washes (p = 0.065), adenovirus was detected in higher proportions in adenoid samples of OME patients than controls (p = 0.019).
Despite both OME and control patients presented similar rates of viruses and bacteria at the adenoid, children with OME presented higher prevalence of S. pneumonia, M. catarrhalis in middle ear and adenovirus in adenoids when compared to controls. These findings could suggest that these pathogens could contribute to the fluid persistence in the middle ear.
Otitis media with effusion (OME) is a common childhood disease characterized by the presence of fluid in the middle ear, with no symptoms and/or signs of acute inflammation [1, 2]. In the United States, approximately 90% of all children develop an episode of OME before they reach school age, mainly between the ages of 4 months and 6 years . The presence of OME is associated with severe negative impact on child development, including hearing loss with long-term consequences for speech and language acquisition, poor school performance, and imbalance issues [1–3]. Moreover, children with OME are five times more susceptible to develop acute otitis media than controls [4, 5].
The Fisher’s exact test was used to compare rates of virus and bacteria detection in both groups of patients. Wilcoxon test was done to assess correlation between bacteria and virus detected in each patient. The analysis was performed using GraphPad Prism 5 (La Jolla, CA, USA).
Although the pathogenesis of OME is not fully understood, there is evidence that adenoid may play an important role in this disease, either by mechanically impairing the Eustachian tube function, or by acting as a microbial reservoir for ascending infection to the middle ear [13, 14, 24]. Children are often exposed to pathogens that may chronically persist in tissues in the upper airways, especially in the adenoid and tonsils [13, 14, 25, 26]. Thus, as the adenoid has an intimate anatomical relation with the Eustachian tube and ultimately to the middle ear, it is important to understand how the presence of microbes in the adenoid could lead to the development or persistence of OME in children.