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Occurrence of middle ear pathogens in the nasopharynx of young individuals. A quantitative study in four age groups
1Department of Otolaryngology, Central Hospital of Keski-Pohjanmaa, Kokkola, Finland.
Insights
Young children harbor significantly more middle ear pathogens in their nasopharynx (NPH). This high pathogen load in the NPH is linked to the increased incidence of acute otitis media (AOM) in this age group.
Area of Science:
- Microbiology
- Pediatrics
- Otolaryngology
Background:
- The nasopharynx (NPH) is a reservoir for respiratory pathogens.
- Acute otitis media (AOM) is a common childhood infection.
- Understanding pathogen colonization in the NPH is crucial for AOM prevention.
Purpose of the Study:
- To quantitatively assess the colonization of middle ear pathogens in the NPH of children across different age groups.
- To investigate the relationship between NPH pathogen load and the incidence of AOM.
Main Methods:
- Quantitative bacterial sampling from the posterior nasopharynx (NPH) of 90 children.
- Children were categorized into four age groups: under 2, 2-5, 6-10, and 11-15 years.
- Exclusion criteria included current AOM, sinusitis, or tonsillitis.
Main Results:
- All children under 2 years old had middle ear pathogens in their NPH, compared to 40% in the oldest group (p<0.001).
- In the youngest group, pathogens constituted over 90% of the NPH bacterial flora, versus 20% in the oldest group (p<0.01).
- A significant accumulation of middle ear pathogens was observed in the NPH of young children.
Conclusions:
- Young children exhibit a higher prevalence and density of middle ear pathogens in the nasopharynx.
- This NPH pathogen accumulation is a likely contributing factor to the high incidence of AOM in infants and toddlers.
- Targeting NPH colonization may be a strategy for AOM prevention in young children.
Abstract:
Colonization of middle ear pathogens (S. pneumoniae, H. influenzae and B. catarrhalis), potential pathogens (S. aureus and coagulase-negative staphylococci) and non-pathogens was determined quantitatively on the posterior wall of the nasopharynx (NPH) of children (four age groups: under 2 years, 2-5 years, 6-10 years and 11-15 years). None of the 90 individuals examined was suffering at the time of bacterial sampling from acute otitis media (AOM), sinusitis, or tonsillitis. All individuals under 2 years of age harboured middle ear pathogens in the NPH, but only 40% of the individuals of the oldest age group (p less than 0.001). Furthermore, in the youngest group, 57% of the cases had pathogens in the NPH, which completely dominated the bacterial flora, i.e. constituted more than 90% of the total bacterial count when calculated as CFU/cm2. The corresponding count in the oldest age group was only 20% (p less than 0.01). One important reason for the high incidence of AOM among young children in particular seems to be the noticeable accumulation of middle ear pathogens in huge quantities in the NPH in this age group.