[Infectious and non infectious factors in otitis media and in sinusitis]

Infections of the ENT area are frequent and otitis media in children, sinusitis in adults are generally attributed to viruses or bacterial species. However many non infectious factors play an important role and may lead to useless antibiotic treatments. In otitis media, several factors such as mechanical defect in Eustachian tube, immature immunity, passive tobacco environment are capable to initiate a first viral step of otitis media, followed by bacterial infection due to S. pneumoniae, H. influenzae or Moraxella catarrhalis. Sinusitis are associated to multiple factors and mechanical as well as infective agents (viruses and bacteria) are well established. But several non infectious factors should be analysed and one major factor is allergy which is responsible for repeated sinusitis. Diabetes, anatomical factors, inappropriate muco-ciliary structure, HIV immunodepression can play a significant role in non infectious sinusitis. More work should be done to improve understanding of these complex mechanisms.