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At least 19 recordsLinked to original sources
PubMed1996

Platelet-activating factor and leukotrienes in acute otitis media, secretory otitis media, and chronic otitis media on the acute excerbation.

The present study was carried out for the purpose of measuring platelet activating factor (PAF) and leukotrienes (LTs) in middle ear fluid (MEF) or in otorrhea of children with acute otitis media (AOM), with secretory otitis media (SOM), and with chronic otitis media (COM) on the acute exacerbation. PAF, LTC4, and LTD4+LTE4 concentrations were measured by radioimmunoassay in purulent MEFs obtained from 15 ears of 15 children with AOM, in mucoid or gluey MEFs from 16 ears of 15 children with SOM, and in purulent otorrhea from 9 ears of 9 children with COM on the acute exacerbation. PAF concentrations were 25.4 +/- 9.0 ng/mg total phospholipid (TPL) in AOM, 4.9 +/- 1.9 ng/mg TPL in SOM, 20.7 +/- 15.7 ng/mg TPL in COM, demonstrating significant differences between AOM and SOM (p < 0.05) and between COM and SOM (p < 0.01). LTC4 concentrations were 92.9 +/- 73.8 pg/mg total protein (TP) in AOM, 52.0 +/- 42.5 pg/mg TP in SOM, and 28.5 +/- 11.2 pg/mg TP in COM. LTD4+LTE4 concentrations were 326.5 +/- 177.0 pg/mg TP in AOM, 288.2 +/- 144.6 pg/mg TP in SOM, and 94.0 +/- 58.1 pg/mg TP in COM, demonstrating significant differences between AOM and COM and between SOM and COM (p < 0.01). The results obtained indicated that PAF was involved in the onset of AOM and COM on the acute exacerbation, and that LTs played an important role in SOM.

Acute Disease↗
PubMed2005

Randomized, investigator-blinded, multicenter, comparative study of gatifloxacin versus amoxicillin/clavulanate in recurrent otitis media and acute otitis media treatment failure in children.

BACKGROUND: Recurrent otitis media and acute otitis media treatment failure are commonly encountered in the pediatric population. OBJECTIVE: To compare the clinical efficacy of gatifloxacin with amoxicillin/clavulanate for the treatment of acute otitis media treatment failure and recurrent otitis media. METHODS: Three hundred fifty-four children 6 months-7 years with recurrent otitis media and/or acute otitis media failure were stratified according to age (younger than 2 years versus 2 years or older) and then randomly assigned to 10 days of treatment with gatifloxacin 10 mg/kg once daily or amoxicillin/clavulanate 90 mg/6.4 mg in 2 divided doses. Tympanocentesis was performed in 116 children with acute otitis media treatment failure and 52 with recurrent otitis media at study entry to validate the clinical diagnosis and provide microbiologic data. The primary outcome measure was clinical resolution of infection at the test-of-cure visit 3-10 days after completing treatment. RESULTS: Clinical resolution of acute otitis media was observed in 79.0% (49 of 62) of clinically evaluable children younger than 2 years and 90.3% (56 of 62) of those 2 years or older who were treated with gatifloxacin as compared with 77.6% (45 of 58) of children younger than 2 years and 79.7% (47 of 59) of children 2 years or older treated with amoxicillin/clavulanate. In patients with acute otitis media treatment failure, clinical response rates for children younger than 2 years and those 2 years or older were 87.5% (21 of 24) and 97.0% (32 of 33) with gatifloxacin versus 63.6% (14 of 22) and 83.9% (26 of 31) with amoxicillin/clavulanate. The corresponding clinical response rates in patients with recurrent otitis media were 79.2% (19 of 24) and 85.7% (18 of 21) with gatifloxacin and 90.5% (19 of 21) and 76.0% (19 of 25) with amoxicillin/clavulanate. Clinical success in those subjects having pretreatment middle ear fluid pathogens was similar for the 2 regimens [80.0% (24 of 30) gatifloxacin, 77.1% (27 of 35) amoxicillin/clavulanate]. Emergence of fluoroquinolone-resistant strains was not observed. Both drugs were generally well-tolerated. Diarrhea was the most common drug-related adverse event (10% gatifloxacin, 18% amoxicillin/clavulanate). No evidence of abnormal joint or gait findings was found during a 12-month follow-up. CONCLUSIONS: Gatifloxacin once daily is at least as effective and well-tolerated as amoxicillin/clavulanate twice daily in children with acute otitis media treatment failure or recurrent otitis media. There was no evidence of arthrotoxicity or emergence of fluoroquinolone-resistant bacteria in gatifloxacin-treated children.

Acute Disease↗
PubMed2000

Antibiotics for acute otitis media in children.

BACKGROUND: Acute otitis media is one of the most common diseases in early infancy and childhood. Antibiotic use for acute otitis media varies from 31% in the Netherlands to 98% in the USA and Australia. OBJECTIVES: The objective of this review was to assess the effects of antibiotics for children with acute otitis media. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, Index Medicus, Current Contents and reference lists of articles from 1958 to January 1999. SELECTION CRITERIA: Randomised trials comparing antimicrobial drugs with placebo in children with acute otitis media. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Nine trials were eligible but only six trials, with a total of 1,962 children, included patient-relevant outcomes. The methodological quality of the included trials was generally high. All trials were from developed countries. The trials showed no reduction in pain at 24 hours, but a 34% relative reduction (95% confidence interval 16% to 48%) in pain at two to seven days. Since approximately 85% of patients will have settled spontaneously in this time, this means an absolute reduction of about 5% or that about 20 children must be treated with antibiotics to prevent one child having some pain after two days. There was no effect of antibiotics on deafness, as measured by subsequent tympanometry, other complications, or recurrence. However, audiometry was done in only two studies and incompletely reported, and there were few serious complications seen in these trials: only one case of mastoiditis occurred (in a penicillin treated group). One semi-randomised trial in Sweden in 1954 reported a rate of 17% in the untreated group versus none in the penicillin treated groups. REVIEWER'S CONCLUSIONS: Antibiotics provide a small benefit for acute otitis media in children. As most cases will resolve spontaneously, this benefit must be weighed against the possible adverse reactions. Antibiotic treatment may play an important role in reducing the risk of mastoiditis in populations where it is more common.

Acute Disease↗
PubMed1989

[Evaluation of the efficacy of ceftriaxone in acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media. A comparative study with cefotiam as the control].

In order to objectively evaluate the efficacy and the safety of ceftriaxone (CTRX) using once daily administration of 1 g to cases of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media, a group comparison study by the envelope method was conducted using cefotiam (CTM) as the control drug (2 g twice daily). The results obtained are summarized as follows. 1. Clinical efficacies evaluated by the committee were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 63% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered both groups evidenced a clinical efficacy of 64%, and no significant difference was observed between the 2 groups. 2. Clinical efficacies evaluated by the physician in charge were 65% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 60%, respectively, for chronic suppurative otitis media. When all cases were considered efficacies were, respectively, 70% and 64%, showing no significant difference between the 2 groups. 3. Bacteriological efficacies were 88% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 74% and 62%, respectively, for chronic suppurative otitis media. With all cases bacterial eradication rates were, respectively, 76% and 67%. Bacterial eradication rates were always higher for the CTRX group than for the CTM group, but the difference was not significant between the 2 groups. 4. Against infections caused by Staphylococcus aureus alone, CTRX showed equal clinical and bacteriological efficacies to CTM. 5. As side effects, dermatitis, vomiting, and malaise were observed in 5 cases (4%) of the CTRX group and 3 cases (3%) of the CTM group. As clinical testing abnormalities, elevations of GOT, GPT, and Al-P, and thrombocytopenia were noted only in 3 cases (5%) of the CTRX group. Furthermore, all of these abnormalities were temporary and of moderate degree or mild, thus the safety of either drug was considered high. 6. Clinical utilities were 71% in the CTRX group and 86% in the CTM group for acute suppurative otitis media, and 72% and 62%, respectively, for chronic suppurative otitis media. When all cases were included, they were 72% and 66%, respectively, and there was no significant difference between the 2 groups. It is concluded from the above results that CTRX is a highly useful drug with once daily administration of 1 g in the treatment of suppurative otitis media.

Adolescent↗
PubMed2005

Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion.

OBJECTIVES: Children under 2 years of age with acute otitis media are known to have a relatively poor prognosis. The objective of this study was to assess whether known determinants for recurrent acute otitis media and persistent middle ear effusion after an episode of acute otitis media during childhood also apply to children under 2 years. METHODS STUDY DESIGN: prospective study of 210 children under 2, with identification of potential prognostic determinants. Univariate and multivariate logistic regression analyses were applied to evaluate which parameters independently contributed to the prediction of both outcome measures (recurrent acute otitis media and persistent middle ear effusion). A prognostic function was developed, and the area under the receiving operating characteristic (ROC) was used to estimate the predictive ability of the prognostic models. POPULATION: children under 2 years of age with an episode of acute otitis media in family practice. OUTCOMES MEASURED: recurrent acute otitis media and persistent middle ear effusion. RESULTS: For the outcome recurrent acute otitis media data from 210 children were used and winter season, male sex, passive smoking and persistent symptoms for more than 10 days at presentation were independent prognostic determinants. For the outcome persistent middle ear effusion data from 190 children were used and winter season, bilateral disease at entry, a sibling history of recurrent acute otitis media, and a previous episode of acute otitis media independently predicted the outcome. No sufficiently discriminatory prognostic model could be constructed for either outcome measure. CONCLUSION: Prediction of recurrent acute otitis media or persistent middle ear effusion in individual young children remains poor.

Acute Disease↗
PubMed1983

[Double-blind comparative trial of cefroxadine and cephalexin in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media].

A double-blind controlled trial of cefroxadine (CXD) 250 mg t.i.d. was undertaken to objectively evaluate its safety and effectiveness in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media, using cephalexin (CEX) 250 mg q.i.d. as a control drug, and the following results were obtained. In the treatment of acute suppurative otitis media, the 2 drugs produced almost equal outcomes, showing no significant difference in assessments of both overall effects and usefulness. In the treatment of acute exacerbation of chronic suppurative otitis media, the 2 drugs exhibited no significant difference as well in overall effects by Wilcoxon's two-sample test. However, the CEX group had significantly more nonresponsive patients, i.e. 35.5% as compared with 9.7% of the CXD group (chi 2-test, P less than 0.05). In the assessment of clinical usefulness as well, no significant difference was observed between the 2 groups. In the assessment of overall effects based on the patients whose isolated organisms were sensitive to the drugs, CEX group had more patients not responding to the treatment of acute exacerbation of chronic suppurative otitis media (chi 2-test, P less than 0.05). Bacteriological effects were not significantly different between the 2 drugs in both acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media. Overall safety rating was not significantly different between the 2 drugs. Side effects occurred as the symptoms of digestive organ in 2 patients each in both groups (equally an incidence of 2.6%). As for the improvement of each symptom after treatment (assessed on day 3), CXD was superior in the improvement rate of otorrhea volume as the main symptom of acute exacerbation of chronic suppurative otitis media, while CEX was superior in that of otoobstruction feeling. From the above findings, it is presumed that CXD is a safe drug which can exhibit equal or superior therapeutic effects to CEX in the treatment of acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media, at 3/4 of the CEX dose level.

Adolescent↗
PubMed1987

Medical profile of the language-delayed child: otitis-prone versus otitis-free.

Delay in language development may be associated with an underlying anatomical, neurosensory, or psychological disorder such as: deafness, cerebral palsy, cleft palate, autism, or mental retardation. A condition called specific developmental language delay may occur in children devoid of any other identifiable disorder or developmental delay. Language delay associated with early onset, severe-to-profound hearing impairment has been well documented. Controversial studies have also appeared in the communicative disorders' literature suggesting that fluctuating conductive hearing loss in early childhood can significantly affect the development of language and related academic skills. Some authors have claimed that these deleterious effects can be irreversible. This study focuses on 3 groups of preschool children, in whom hearing acuity has been documented: One group with recurrent otitis and language delay; a second group with an equally well documented otitis history but without language delay; and a third group with documented language delay in the absence of any known predisposing conditions, including early-onset, recurrent otitis media. Prenatal, birth and developmental histories of the children in each group were compared in detail to identify any factors which may enhance or ameliorate the effects of fluctuating conductive hearing loss on language development. In a population of 1864 children (ages 9-59 months) referred for otolaryngologic and/or communicative evaluation, 480 otherwise normal children (67.6% males; 32.4% females) were found to have a history of early-onset, recurrent otitis media and/or delayed speech and language development on the basis of an extensive evaluation battery. This population was further subdivided into 3 groups (I = otitis-positive/normal language; II = otitis-positive/language delay; and III = otitis-free/language delay). Among the 329 children with positive histories for early otitis media (Groups I & II), a significantly higher percentage of those demonstrating language delay were from homes in the lower socio-economic category. Race and sex showed no significant relationship to language delay among the otitis-positive groups, although males were twice as numerous as females in the over-all study population. Articulation errors on speech measures and borderline delays in other developmental milestones (standing, walking, and toilet training) were also significantly greater in the language-delayed group when compared with otitis-positive children whose language was age-appropriate.(ABSTRACT TRUNCATED AT 400 WORDS)

Child Development↗
PubMed1986

Otitis media in Greenland children: acute, chronic and secretory otitis media in three- to eight-year-olds.

The middle ear status was examined in 142 children aged three to eight years from Sukkertoppen and Kangamiut in Greenland. The investigation is based on social-pediatric and otologic histories and on objective examination using otomicroscopy and tympanometry. Three-fourths of the small children had a previous history of otitis, some with repeated instances. Otomicroscopic findings revealed suppurative, chronic otitis in 6% and sequelae of chronic otitis in 13%. Tympanometry disclosed a reduced middle ear pressure in another 26% of the ears examined. Comparison of children with healthy ears with the groups with affections of the middle ear showed a tendency to an increased risk of otitis in families at a low social stratum, whereas the mode of habitation seemed insignificant. Finally, a large milk intake both in connection with breast-feeding and later in life seemed to reduce the frequency of otitis. The investigation showed that acute otitis and chronic otitis media in particular are more prominent in Greenland than in Denmark. Attention is drawn to the handicap associated with a high incidence of chronic otitis media and the concomitant hearing loss to a population isolated in point of language. The successful achievements of a health information campaign and an active therapeutic program, which has reduced the prevalence of chronic otitis among the Innuit population native to Alaska and Canada, provides the rationale for an increased otologic effort in Greenland.

Acute Disease↗
PubMed1985

A history of acute suppurative otitis media and allergic symptomatology in children with chronic secretory otitis media and controls.

The parents of children with secretory otitis media and the parents of healthy children attending for routine school or community medical examinations have been questioned about previous acute otitis media, aural discharge, chronic nasal symptoms and allergic disorders. Eighty-nine pairs of children, matched for age and sex, were available for analysis. There was a significantly higher incidence of acute otitis media, aural discharge and chronic nasal symptoms in the secretory otitis group (P = less than 0.001). Amongst the allergic symptoms and disorders, the only significant differences demonstrated were for drug allergy, eye itching and eye running (P = less than 0.05). The results confirm that a relationship exists between acute otitis media and secretory otitis media and also support the conventional image of the child with secretory otitis as a mouth breather with nasal symptoms. They do not lend support to the view that allergy is an important factor in the pathogenesis of secretory otitis.

Acute Disease↗
PubMed2006

The posterior attic: An observational study of aboriginal Australians with chronic otitis media (COM) and a theory relating to the low incidence of cholesteatomatous otitis media versus the high rate of mucosal otitis media.

OBJECTIVE: The incidence of COM without cholesteatoma in Australian aboriginals is quoted as being between 25 and 47%. The incidence of cholesteatomatous OM is very low in comparison (between 1 and 3%). A comprehensive literature search found no studies offering an explanation for the large discrepancy between these two types of OM. We offer a theory to account for the disproportionate rates of the two types of OM together with an observational study on aboriginals with COM to substantiate our argument. METHOD/RESULTS: The crux of our hypothesis centres on the anatomy of the posterior attic. We found that in a study of 40 aboriginal patients undergoing tympanoplasty with audiometric evidence of an intact ossicular chain that, after posterior tympanomeatal flap elevation, no part of the incudostapedial assembly was visible in 95% of cases denoting its location behind the posterior attic wall. CONCLUSION: We hypothesise that in aboriginal ears the resulting 'crowding' of the posterior attic by the incudostapedial assembly results in narrowing of the epitympanic space which compromises atticoantral drainage, thus leading to mucosal COM, however supporting the posterior-superior segment of the tympanic membrane, impeding the formation of a retraction pocket, and cholesteatoma formation migrating into the mastoid antrum.

Adolescent↗
PubMed1995

Risk factors for chronic otitis media with effusion in infancy. Each acute otitis media episode induces a high but transient risk.

OBJECTIVE: To examine the effects of a history of acute otitis media and different extrinsic factors on the risk of chronic otitis media with effusion in infancy. DESIGN: A retrospective birth cohort with a 2-year follow-up. Infection data were gathered from medical records and background information came from questionnaires. The monthly risk of chronic otitis media with effusion was dynamically modeled to control the confounding effects and time-dependency of the risk factors. SETTING: Primary health care centers, hospitals, and private practices in 10 randomly selected local government districts in the two northern most provinces of Finland. SUBJECTS: A random sample of 2512 children from the cohort. MAIN OUTCOME MEASURES: Chronic otitis media with effusion, defined as a minimum of 2 months of middle-ear effusion, usually is disclosed by tympanocentesis and specific operative findings. RESULTS: Previous acute otitis media episodes were the greatest risk factor. Each acute episode induced a highly increased risk (odds ratio, 11.9; 95% confidence interval, 5.7 to 24.9) that disappeared in 3 months. Successive episodes were risky, but this risk also decreased rapidly. Other significant risk variables were attendance at a day nursery (odds ratio, 2.56; confidence interval, 1.17 to 5.57), male sex (odds ratio, 2.17; confidence interval, 1.37 to 3.44), and autumn season (odds ratio, 1.99; confidence interval, 1.11 to 3.55). CONCLUSIONS: Acute otitis media episodes constitute the greatest risk of chronic otitis media with effusion. Each episode has a high transient risk for 3 months but no further direct effect on the risk.

Acute Disease↗
PubMed2004

Antibiotic susceptibility of acute otitis media pathogens in otitis-prone Belgian children.

UNLABELLED: A regional surveillance study was carried out in children with recurrent acute otitis media (AOM) to determine the antimicrobial susceptibility of three common AOM pathogens. Susceptibility to relevant antimicrobial agents was determined on 149 Streptococcus pneumoniae, 246 Haemophilus influenzae and 119 Moraxella catarrhalis strains isolated between January 1999 and January 2002, either from the nasopharynx or middle ear of 74 children with recurrent AOM, the majority (77%) being otitis-prone. Overall pneumococcal resistance to penicillin was 9.4% (6.7% penicillin-intermediate resistant, 2.7% penicillin-resistant), whereas cotrimoxazole and erythromycin resistance accounted for 25.5% and 38.9% respectively. The prevalence of antimicrobial-non-susceptible S. pneumoniae was the highest in middle ear isolates (P<0.05) and in otitis-prone children (P<0.01). Moreover, otitis-prone children harboured significantly more pneumococci resistant to at least two antimicrobial agents (24.3% versus 7.4%; P<0.01). No patient age related variation was observed. Five serogroups (6, 19, 23, 14 and 9) covered by the 7-valent pneumococcal conjugate vaccine, constituted most of the antibiotic resistant pneumococci. Among nasopharyngeal and middle ear H. influenzae isolates, 17.1% were resistant to ampicillin and 16.3% to cotrimoxazole. For M. catarrhalis, 92.4% of all isolates was ampicillin-resistant. CONCLUSION: This study confirms international and national differences in antimicrobial susceptibility profiles of three acute otitis media pathogens with relatively favourable antibiotic resistance rates in Belgian children with frequent acute otitis media. This "at risk" population of otitis-prone children is shown to harbour more antimicrobial resistant and multidrug resistant pneumococci. If antimicrobial therapy in this group of children is indicated, high dose amoxicillin is recommended whereas the use of macrolides is obsolete.

Belgium↗
PubMed1998

Otitis media health status evaluation: a pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment.

There are no reliable and valid instruments that measure otitis media clinical or functional health status in children ages 1 to 3 years. This study develops and tests three new instruments of clinical and functional otitis health status: the Otitis Media Clinical Severity Index (OM-CSI), the Otitis Media Functional Status Questionnaire (OM-FSQ), and the Otitis Media Diary (OMD). The OM-CSI was found to be a reliable measure of clinical acute otitis media (AOM) severity, with high internal consistency (Cronbach's alpha) scores, as well as an accurate indicator of AOM severity. The OM-FSQ and OMD were demonstrated to be reliable and valid measures of otitis-specific functional health status, with reproducible scores over time, high internal consistency alpha scores, and high correlation with measures of AOM clinical severity and other functional health status instruments. These three new instruments were also sensitive and specific indicators of AOM episodes.

Acute Disease↗
PubMed2001

A review of techniques for the investigation of otitis externa and otitis media.

Otitis externa, inflammation of the externa ear canal, is relatively easy to diagnose based on the history and physical examination findings. The diagnosis of otitis media, inflammation of the middle ear cavity, is more challenging, with the work-up being both costly and, at times, invasive. The pathogenesis of otitis externa has been classified into predisposing, primary, and perpetuating factors. It is critical to the management of ear disease that the clinician recognize and investigate which factors are contributing to each individual patient's ear disease. Failure to identify and address the primary and/or predisposing factors is the most common cause of chronic recurrent otitis externa. Chronic inflammation of the ear canal leads to the development of the perpetuating factors, which may be the major reason for treatment failure, regardless of the primary cause of the ear disease. In this article, the predisposing, primary, and perpetuating factors involved in ear disease will be presented, along with a review of the techniques used in the diagnosis of otitis externa and otitis media.

Animals↗
PubMedDate not supplied

Necrotizing otitis externa, otitis media, peripheral facial paralysis, and brain abscess in a thalassemic child after allogeneic BMT.

Severe infection is one of the major complications in the early and late post-bone marrow transplantation period. The authors report a thalassemic child who developed necrotizing otitis externa and otitis media, a very rare complication after bone marrow transplantation, and then peripheral facial nerve paralysis and brain abscess in the early period of bone marrow transplantation despite antibacterial and antifungal prophylaxis. Necrotizing otitis media is characterized by necrosis and sloughing of considerable areas in the middle ear and adjacent tissues and is an unusual disorder because of today's antibiotics. Granulocytopenia and background ear tissue exposed to previous repeated otitis media attacks may be the predisposing factors in this case. The authors conclude that the children with previous histories of recurrent otitis media should be prepared and monitored very carefully during bone marrow transplantation because of the risk of necrotizing otitis media, especially in the granulocytopenic period.

Anti-Bacterial Agents↗
PubMed1979

Lysozyme activity and immunoglobulins in middle ear effusion fluid in acute purulent otitis media and in otitis media with effusion.

147 samples of punctured middle ear effusion fluid from cases of otitis media with effusion and 150 samples from patients with acute purulent otitis media were tested for lysozyme activity. In otitis media with effusion the concentration was 182.0 U/ml, in acute otitis 433.8 U/ml. The lysozyme concentration in otitis media with effusion depended upon the nature of the effusion. Serous fluid showed an activity of 124.8 U/ml and mucoid 311.6 U/ml, respectively. In culture-positive cases of acute otitis media the lysozyme level was 423.4 U/ml. Culture-negative cases showed about the same concentration, 438.3 U/ml. The possible role of lysozyme in defence systems of the middle ear is discussed.

Adolescent↗
PubMed1999

Waldeyer's ring and otitis media: the nasopharyngeal tonsil and otitis media.

This overview of the relationship between the nasopharyngeal tonsil and otitis media will review three important concepts: (1) Adenoid inflammation leads to inflammatory obstruction of the Eustachian tube; (2) early colonization of the adenoid with the three major bacterial pathogens of otitis media is the most important factor in the early pathogenesis of otitis media; (3) the local immune system in the adenoid particularly specific secretory IgA directed against both viruses and bacterial pathogens are probably genetically controlled and represent the immunological factor in protecting the host against invasion of these agents in the Eustachian tube and middle ear. This overview of the relationship between the adenoid and the development of otitis media emphasizes that nasopharyngeal colonization with the three major middle ear pathogens is among the most important risk factors in the pathogenesis of otitis media. Inasmuch as these pathogens normally reside in the nasopharynges of most healthy children, the factors which trigger development of otitis media need to be carefully evaluated. Among these two triggers are viral infections and upper respiratory tract allergy.

Adenoids↗