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Viral respiratory infection in schoolchildren: effects on middle ear pressure
Birgit Winther1, Frederick G Hayden, Eurico Arruda
1University of Virginia Health System, Charlottesville, Virginia 22906, USA. bw8b@virginia.edu
Insights
Common colds in children frequently cause temporary negative middle ear pressure, potentially increasing the risk of ear infections. This study monitored middle ear pressure during colds in school-aged children.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Viral respiratory infections, commonly known as colds, are frequent in school-aged children.
- Middle ear pressure abnormalities can be a precursor to otitis media, a common childhood infection.
Purpose of the Study:
- To investigate the impact of uncomplicated viral respiratory infections (colds) on middle ear pressure in healthy school-aged children.
- To identify potential risk factors and patterns associated with middle ear pressure changes during colds.
Main Methods:
- Bilateral tympanometry was performed daily for two weeks on children (ages 2-12) experiencing a cold.
- Nasopharyngeal secretions were analyzed for viral pathogens (using RT-PCR) and bacterial pathogens of otitis media.
- Abnormal tympanometry was defined by specific pressure and compliance thresholds.
Main Results:
- Two-thirds (66%) of the 86 studied colds resulted in at least one instance of abnormal negative middle ear pressure.
- Respiratory viruses, primarily rhinovirus (48%) and RSV (14%), were detected in 65% of illnesses.
- The occurrence of abnormal tympanometry was not significantly affected by age, viral detection, or bacterial presence, but was higher in winter-spring colds.
Conclusions:
- Transient negative middle ear pressure is a common finding during uncomplicated colds in children.
- This pressure change is likely due to viral nasopharyngeal infection causing eustachian tube dysfunction.
- Tympanometry can objectively assess eustachian tube dysfunction and the risk of otitis media.
Objective:
To evaluate the effect of uncomplicated viral respiratory infections (colds) on middle ear pressure in healthy school-aged children.
Methods:
Children (ages 2-12) with normal tympanograms before onset of illness had bilateral tympanometry daily except weekends for 2 weeks after the onset of a cold. Nasopharyngeal secretion obtained at onset of illness was cultured for bacterial pathogens of otitis media using selective agars and tested for rhinovirus, coronavirus, respiratory syncytial virus, influenza A and B, and parainfluenza 1-3 by reverse transcriptase polymerase chain reaction technology. Tympanometry was designated as abnormal with peak pressure of < or =-100 daPa or > or =50 daPa and/or a compliance peak of < 0.2 cm(3).
Results:
Eighty-six colds were studied, 82 in schoolchildren (5-12 years old) and 4 in 2- to 3-year-olds. Abnormal negative middle ear pressure occurred at least once during the 2 weeks after onset in 57 (66%) of the 86 colds. Tympanometry was abnormal in the first week after onset in 50 (88%) of the 57 colds and was abnormal on a single day in 17 (30%) of the 57. The middle ear pressure abnormalities were intermittent and shifted from one ear to the other ear from day to day. Reverse transcriptase polymerase chain reaction was positive for a respiratory virus in 56 (65%) of the 86 illnesses. Rhinovirus was found in 48% and respiratory syncytial virus in 14%. Pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) were detected in nasopharyngeal secretion in 29 (34%) of the 86 colds; the bacteria were in high titer (> or =10(3) cfu/mL) in 26 of the 29 positive specimens. None developed illness that required a visit to a physician. Age, detection of a respiratory virus, and presence of bacterial pathogen in the nasopharyngeal secretion had a negligible effect on the occurrence of abnormal tympanometry. Occurrence of negative middle ear pressure in winter-spring colds was significantly greater than in fall colds for unexplained reasons.
Conclusions:
Transient negative middle ear pressure occurred in two thirds of uncomplicated colds in healthy children. This negative pressure, which may facilitate secondary viral or bacterial otitis media, seems to result from viral infection of the nasopharynx and distal tube causing bilateral eustachian tube dysfunction. Tympanometry provides an objective measure of the potential beneficial effects of investigational treatments on the risk of eustachian tube dysfunction/otitis media.