The unsolved problem of otitis media in indigenous populations: a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media

Abstract

Background: Otitis media (OM) imposes a great burden of disease in indigenous populations around the world, despite a variety of treatment and prevention programs. Improved understanding of the pathogenesis of OM in indigenous populations is required to advance treatment and reduce prevalence. We conducted a systematic review of the literature exploring the upper airway and middle ear microbiota in relation to OM in indigenous children.

Methods: Papers targeting microbiota in relation to OM in children < 18 years indigenous to Australia, New Zealand, North America, and Greenland were sought. MEDLINE, CINAHL, EMBASE, Cochrane Library, and Informit databases were searched using key words. Two independent reviewers screened titles, abstracts, and then full-text papers against inclusion criteria according to PRISMA guidelines.

Results: Twenty-five papers considering indigenous Australian, Alaskan, and Greenlandic children were included. There were high rates of nasopharyngeal colonization with the three main otopathogens (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) in indigenous children with OM. Middle ear samples had lower rates of otopathogen detection, although detection rates increased when molecular methods were used. Pseudomonas aeruginosa and Staphylococcus aureus were commonly detected in middle ear discharge of children with chronic suppurative OM. There was a significant heterogeneity between studies, particularly in microbiological methods, which were largely limited to culture-based detection of the main otopathogens.

Conclusions: There are high rates of otopathogen colonization in indigenous children with OM. Chronic suppurative OM appears to be associated with a different microbial profile. Beyond the main otopathogens, the data are limited. Further research is required to explore the entire upper respiratory tract/middle ear microbiota in relation to OM, with the inclusion of healthy indigenous peers as controls.

Keywords: Indigenous; Microbiota; Otitis media; Pediatrics; Systematic review.

Fig. 1

Literature search and selection. AOM acute otitis media, AOMwP acute otitis media with perforated tympanic membrane, CSOM chronic suppurative otitis media, OME otitis media with effusion

Fig. 2

Forest plot showing bacteriology in relation to acute otitis media. The data are sorted to indicate detection rates for each bacterium in different indigenous populations. Red diamonds indicate subtotal data for different bacteria in each population. Binks et al. 2011 combines AOM and AOMwP. ± 95% confidence intervals do not account for multiple swabs from the same child, *nasal swabs, ^PCR analysis, CI confidence interval

Fig. 3

Forest plot showing bacteriology in relation to otitis media with effusion. The data are sorted to indicate detection rates for each bacterium in different indigenous populations. Red diamonds indicate subtotal data for different bacteria in each population. ^PCR/next-generation sequencing, U/C unable to calculate

Fig. 4

Forest plot showing bacteriology in relation to chronic suppurative otitis media. The data are sorted to indicate detection rates for each bacterium in different indigenous populations. Red diamonds indicate subtotal data for different bacteria in each population. U/C unable to calculate

Fig. 5

Recommendations for future research of OM microbiology in indigenous children. OM otitis media, URT upper respiratory tract