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Published on: September 7, 2017
Ten-Year Study of the Stringently Defined Otitis-prone Child in Rochester, NY
1From the Center for Infectious Disease and Immunobiology, Rochester General Hospital Research Institute, Rochester, New York.
Insights
Stringent diagnosis of otitis-prone children revealed fewer cases and tube placements. These children showed impaired immune responses to respiratory viruses and bacteria, impacting their susceptibility to acute otitis media (AOM).
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Identifying children prone to recurrent AOM is crucial for effective management.
- Previous definitions of otitis-prone (OP) may overestimate prevalence.
Purpose of the Study:
- To evaluate the impact of a stringent definition for otitis-prone (sOP) children on prevalence.
- To investigate immune system differences between sOP and non-otitis-prone children.
- To explore the relationship between viral infections and AOM in sOP children.
Main Methods:
- Prospective, longitudinal 10-year study.
- Bacterial culture confirmation of middle ear fluid for AOM.
- Stringent definition: 3 AOM episodes in 6 months or 4 in 12 months.
- Immune response assessment: antibody levels, B cell, T cell function, and antigen-presenting cells.
Main Results:
- Stringent diagnosis reduced OP prevalence from 27% to 6%.
- Tympanostomy tube placement decreased from 14.8% to 2.4% with sOP criteria.
- sOP children had higher rates of AOM linked to respiratory syncytial virus (RSV) infection with lower RSV-specific IgG.
- sOP children exhibited reduced antibody production to key otopathogens and impaired cellular immunity.
Conclusions:
- A stringent definition of otitis-prone status significantly lowers the number of identified children and tympanostomy tube insertions.
- Otitis-prone children demonstrate distinct immunological deficits, including impaired responses to RSV and common bacterial otopathogens.
- These immune deficiencies may contribute to increased susceptibility to AOM and highlight potential targets for therapeutic interventions.
Abstract:
This review summarizes a prospective, longitudinal 10-year study in Rochester, NY, with virtually every clinically diagnosed acute otitis media (AOM) confirmed by bacterial culture of middle ear fluid. Children experiencing 3 episodes within 6 months or 4 episodes in 12 months were considered stringently defined otitis prone (sOP). We found stringent diagnosis compared with clinical diagnosis reduced the frequency of children meeting the OP definition from 27% to 6% resulting in 14.8% and 2.4% receiving tympanostomy tubes, respectively. Significantly more often respiratory syncytial virus infection led to AOM in sOP than non-otitis-prone children that correlated with diminished total respiratory syncytial virus-specific serum IgG. sOP children produced low levels of antibody to Streptococcus pneumoniae and Haemophilus influenzae candidate vaccine protein antigens and to routine pediatric vaccines. sOP children generated significantly fewer memory B cells, functional and memory T cells to otopathogens following nasopharyngeal colonization and AOM than non-otitis-prone children and they had defects in antigen-presenting cells.
