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[TREATMENT OF SECRETORY OTITIS MEDIA IN CHILDREN, DEPENDING ON THE STAGE OF THE PROCESS AND ON THE BACKGROUND OF THE
E Kulikova1, N Golovko1, A Chumakova1
1Kharkiv National Medical Academy of Postgraduate Education; Kharkiv National University named after V.N. Karazin, Ukraine.
Insights
This study investigated secretory otitis media (SOM) in children, linking Epstein-Barr virus (EBV) and nasopharyngeal microflora to immune status. Targeted immunocorrection improved outcomes and reduced SOM relapses, highlighting personalized treatment approaches.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Immunology
Background:
- Secretory otitis media (SOM) is common in children, often influenced by infectious agents and immune system status.
- Previous research indicates a potential link between Epstein-Barr virus (EBV) and other pathogens with SOM development.
- Understanding these associations is crucial for developing effective, individualized treatment strategies.
Purpose of the Study:
- To develop personalized treatment regimens for pediatric secretory otitis media (SOM).
- To assess the impact of Epstein-Barr virus (EBV) infection, nasopharyngeal microflora, and immunogram results on SOM.
- To evaluate the efficacy of immunomodulatory agents in managing SOM and preventing relapses.
Main Methods:
- Conducted in-depth examinations of 68 children diagnosed with SOM between 2017-2019.
- Utilized enzyme-linked immunosorbent assay (ELISA) to detect EBV serological markers (IgM, IgG).
- Performed bacteriological analysis of the nasopharynx and level 1 immunograms; administered immunomodulatory treatments (thymalin, Broncho-Vaxom) based on findings.
Main Results:
- Identified EBV infection in 45.6% of children with SOM (16.2% acute, 20% previous).
- Observed decreased cellular immunity (T-lymphocyte subpopulations) in EBV-infected children.
- Common nasopharyngeal pathogens included Streptococcus pyogenes, H. influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.
- Children receiving immunocorrection showed significantly fewer SOM relapses and improved immune indicators.
Conclusions:
- EBV infection and specific nasopharyngeal microflora are associated with altered immune status in children with SOM.
- Personalized treatment incorporating immunomodulatory agents like thymalin and Broncho-Vaxom is effective in reducing SOM relapses.
- This approach, guided by comprehensive diagnostics, offers a promising strategy for managing pediatric secretory otitis media.
Abstract:
The purpose of the work is to develop individual treatment regimens for children with secretory otitis media (SOM) depending on the results of an in-depth examination of them, in particular, the identification of Epstein-Barr virus (EBV), the presence of pathogenic microflora in the nasopharynx and the results of a level 1 immunogram. Laboratory examination for the presence of serological markers: IgM to the capsid complex (VCA), IgG to the early antigen (EA) and the nuclear antigen EBNA in the blood serum by enzyme-linked immunosorbent assay (ELISA). 68 children were exposed, children's department of the 30th hospital. Kharkiv during 2017-2019 with a diagnosis of secretory otitis media. The same children underwent a classic bacteriological study of the nasopharynx and level 1 immunogram. Among 68 children with secretory otitis media, a high percentage (16.2%) of infected patients with acute EBV in the acute phase and 20 children previously infected were detected. In total, out of 68 children, 31 (45.6%). In most SOM infected children with EBV, a decrease in the cellular component of immunity was revealed: a decrease in the subpopulations of T-lymphocytes from CD4 helper cells and CD16 from NK killer cells. Streptococcus pyogenes-13 (19.1%) cases prevailed in the nasopharynx in children with SOM, 2nd in frequency. H.influenza was detected in 13 cases (19.1%), Streptococcus pneumonia, the third strain, 11 strain (16.2%), and the fourth, Staplylooccus aureus, 12 strains (17.6%) were seeded 3rd in frequency. The lowest levels of immunograms were found in children infected with EBV. Immunocorrection, require and carriers of streptococci (other drugs). Therefore, the examined children, divided into 3 groups, received various immunomodulating agents: thymalin and Broncho-Vaxom (bacterial lysate), and in some cases we combined topical administration of thymalin with endaural phonophoresis followed by treatment with Broncho-Vaxom. It was these children who had the least number of relapses SOM of against the background of the best indicators of immunity.
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