Importance of respiratory viruses in acute otitis media

Abstract

Acute otitis media is usually considered a simple bacterial infection that is treated with antibiotics. However, ample evidence derived from studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in the etiology and pathogenesis of acute otitis media. Viral infection of the upper respiratory mucosa initiates the whole cascade of events that finally leads to the development of acute otitis media as a complication. The pathogenesis of acute otitis media involves a complex interplay between viruses, bacteria, and the host's inflammatory response. In a substantial number of children, viruses can be found in the middle-ear fluid either alone or together with bacteria, and recent studies indicate that at least some viruses actively invade the middle ear. Viruses appear to enhance the inflammatory process in the middle ear, and they may significantly impair the resolution of otitis media. Prevention of the predisposing viral infection by vaccination against the major viruses would probably be the most effective way to prevent acute otitis media. Alternatively, early treatment of the viral infection with specific antiviral agents would also be effective in reducing the occurrence of acute otitis media.

FIG. 1.

Proposed sites of influence of some risk factors for AOM.

FIG. 2.

Temporal development of AOM after the onset of upper respiratory symptoms. Data derived from reference (grey bars) and reference (black bars).

FIG. 3.

Presence of bacteria and viruses in MEF specimens of children with AOM. Bacteria were detected by culture; viruses were detected by viral culture and/or antigen detection. Data derived from references , , , and .

FIG. 4.

Concentrations of IL-8 and LTB4 in MEF specimens of children with AOM according to the presence of viruses or bacteria in MEF. Open bars, viruses only; grey bars, bacteria only; black bars, both viruses and bacteria in the MEF. Data derived from reference .