Otitis media with effusion in children: cytokines profile, nasopharyngeal colonization and prevention of recurrence

ABSTRACT

Otitis media with effusion [OME] is a common disease in children and there is a growing evidence that bacterial infection and immune response to bacteria and /or its antigens might be involved in the initiation and prolongation of OME. The present study was designed to characterize the pattern of nasopharyngeal colonization, effusion and serum cytokines in children with OME and to evaluate the possibilities of preventing recurrence by bacterial vaccination. 50 patients with OME and 50 subjects [control group] were enrolled in this study. The study groups were subjected to bacteriofogic and immunologic analysis, in addition the patients group was classified into 2 subgroups [group A and B] according to postoperative administration of bacterial vaccine to evaluate its effect in prevention of recurrence. Positive nasopharyngeal cultures were 100% in the patients group compared to 82% in the control group. IL-6 was detected in [60%] of middle ear effusions [MEEs] [33.65 +/- 29. 76 pg/ml], IL-8 in [80%] [52.60 +/- 30.88 pg/ml] while TNF-alpha was detected in only [54%] [26.24 +/- 24. 80 pg/ml]. The levels of IL-6, IL-8 and TNF- alpha in the serum were significantly higher in comparison to their levels in the MEEs of the same patients group [P<0. 05]. Also the levels of these cytokines in the serum of patients group were significantly increased compared to that in serum of the control group. In patients who received postoperative vaccination [group A] [7.1%] showed OME recurrence in 3 -years follow up period, while 31.8% of non_immunized group [group B] showed recurrence during the same follow up period. In conclusion, these data suggest a regulatory role for cytokines in OME. Our clinical experience with the use of polyvalent bacterial vaccination proved to be effective in preventing recurrence of this disease. However, further studies is needed to assess the impact of vaccination on reduction of bacterial colonization