Does Helicobacter pylori have role in development of otitis media with effusion?

Tracing of Helicobacter pylori in the middle ear and mastoid mucosa of patients under 18 years of age with chronic otitis media (with and without cholesteatomas)

OBJECTIVE

It has been estimated that about 5 million people of those affected with otitis media have cholesteatoma, however, its pathophysiology is unclear. In this study we aimed to detect Helicobacter pylori via polymerase chain reaction and real-time polymerase chain reaction in young patients with chronic otitis media.

METHODS

Patients included in our prospective cross-sectional study had middle-ear/mastoid inflammation and underwent surgical procedures. Middle-ear mucosa samples were collected, and genomic DNA was extracted for H pylori detection by polymerase chain reaction and real-time polymerase chain reaction analyses. Sociodemographic data and gastroesophageal reflux symptoms were analysed.

RESULTS

We included 49 patients with mean age of 12.7 ± 3.8 years. Twenty per cent of the patients were diagnosed with cholesteatoma. No increase in H pylori-amplified fluorescence was observed, indicating absence of H pylori.

CONCLUSION

Due to the absence of amplification for H pylori and the fact that albumin was amplified in all samples, we conclude that H pylori does not appear to be a causal factor.

Possible Role of Helicobacter pylori in Ear Nose and Throat Diseases

Background

Helicobacter pylori is assumed to cause many gastric and extragastric diseases. We aimed to assess the possible association role of H. pylori in Otitis media with effusion (OME), nasal polyps and adenotonsillitis.

Patients and Methods

A total of 186 patients with various ear, nose and throat diseases were included. The study comprised 78 children with chronic adenotonsillitis, 43 children with nasal polyps and 65 children with OME. OME patients were assigned to two subgroups: those who have and those who did not have adenoid hyperplasia. Among the patients with bilateral nasal polyps, 20 individuals had recurrent nasal polyps and 23 had de novo nasal polyps. Patients who have chronic adenotonsillitis were divided into three groups: those with chronic tonsillitis and those who underwent tonsillitis, those with chronic adenoiditis and adenoidectomy was performed, and those with chronic adenotonsillitis and underwent adenotonsillectomy. In addition to examination of H. pylori antigen in stool samples of all included patients, real-time polymerase chain reaction (RT-PCR) for detection of H. pylori in the effusion fluid was performed, additionally, Giemsa stain was used for detection of H. pylori organism within the tissue samples when available.

Results

Frequency of H. pylori in effusion fluid was 28.6% in patients with OME and adenoid hyperplasia, while in those with OME it was only 17.4% with a p value of 0.2. Nasal polyp biopsies were positive in 13% patients of denovo, and 30% patients with recurrent nasal polyps, p=0.2. De novo nasal polyps were more prevalent in the positive stools than recurrent ones, p=0.7. All adenoid samples were negative for H. pylori, only two samples of tonsillar tissue (8.3%) were positive for H. pylori, and stool analysis was positive in 23 patients with chronic adenotonsillitis.

Conclusion

Lack of association between Helicobacter pylori and occurrence of OME, nasal polyposis or recurrent adenotonsillitis.

The association between Helicobacter pylori and chronic otitis media with effusion

PURPOSE

Chronic otitis media with effusion (COME) is a common condition in children and a leading cause for hearing loss and ventilation tubes (VT) insertion. Among other risk factors, it is suggested that Helicobacter pylori (H. pylori) infection may have a role in the pathogenesis of COME. Previous studies have reached different results, and therefore, there is a need for further data on the relationship between H. pylori infection and COME development in children. Our objective is to investigate the presence of H. pylori in the middle-ear fluid (MEF) from children with COME.

METHODS

A Comparative cross-sectional study. Children ≤ 18 years were included. The study group included children diagnosed with COME and required VT insertion. The control group included children with acute otitis media (AOM) who required myringotomy in the emergency room. Middle-ear fluid samples were sent for both culture and bacterial identification using polymerase chain reaction (PCR) testing.

RESULTS

A total of 43 children were included. Eighteen with COME (median age 4 years, IQR 3-6), and 25 with AOM (median age 1 year, IQR 1-2). All samples were cultured for H. pylori. Twenty-two samples underwent H. pylori PCR testing of them, 12 samples from children with COME, and 10 from children with AOM. All cultures and PCR tests results were negative for H. pylori.

CONCLUSIONS

Our results suggest that H. pylori does not have a role in the pathogenesis of COME. Future larger studies are needed to investigate whether H. pylori has a role in the pathogenesis of COME.

The Relationship Between Otitis Media With Effusion and Gastroesophageal Reflux Disease: A Meta-analysis

OBJECTIVE

Recent studies have investigated the mechanism by which refluxed gastric materials reach the middle ear, to establish otitis media with effusion (OME) causal relation between them in both children and adults. Therefore, the relationship between OME and gastro-esophageal reflux disease (GERD) should be further studied extensively.

METHODS

To identify eligible original articles, we searched a range of computerized databases, including Medline via PubMed, EMBASE, CNKI, and Web of Science with a systematic searching strategy. Subgroup analysis was performed to analyze heterogeneity and Egger and Begg funnel plot to assess the publication bias of the included articles.

RESULTS

The meta-analysis had an overall sample size of 1961. We identified a significant relationship between OME and GERD, with a pooled odds ratio (OR) of 4.52 (95% confidence interval [CI]: 2.42-8.44; p < 0.001). The pooled data were calculated with the random-effects model as a high significant heterogeneity was found among the studies and there was no significant publication bias observed.

CONCLUSIONS

The meta-analysis suggested that there was a significant association between otitis media with effusion and gastroesophageal reflux disease.

Outcome of Gastroesophageal Reflux Therapy in Children with Persistent Otitis Media with Effusion

Introduction Otitis media with effusion (OME) is considered one of the most common disorders that affect children during the first years of life. There are many risk factors of persistent middle ear effusion; one of these risk factors is gastroesophageal reflux. Association between persistent OME and gastroesophageal reflux diseases (GERDs) could be explained by respiratory tract infections, insufficient ciliary clearance, and poor drainage of the Eustachian tube.

Objective To investigate whether the control of gastroesophageal reflux plays a role in the management of persistent OME and decreases tympanostomy tube insertion

Method A cross-sectional study was conducted on 50 children complaining of persistent OME. Their ages ranged between 5 and 12 years old. All children were subjected to full history taking, audiological assessment and 24-hour esophageal pH monitoring. The study group was divided according to pH results into two groups: GERD positives and GERD negatives.

Result The prevalence of GERD in persistent OME was 58%. There were statistically significant differences in the hearing levels and middle ear condition before and after the treatment (p < 0.05). The percentage of improvement of children complaining of persistent OME after antireflux treatment was 52%.

Conclusion Gastroesophageal reflux disease should be considered in patients with persistent OME. The administration of proton pump inhibitor (PPI) can set aside superfluous surgical treatment (such as tympanostomy).

Otitis media with effusion: The role of Helicobacter Pylori in its pathogenesis

BACKGROUND

Otitis Media with Effusion (OME) is the most common disease of the middle ear. Different factors play a role in its pathogenesis, such as viral and bacterial infections, allergy, morphological and functional changes of nasal passage, Eustachian Tube (ET), and cleft palate. This study aims to investigate the Helicobacter Pylori presence in middle ear effusions from patients with OME through RT-PCR and compare our results with results from other published articles.

METHODS

The study was carried out from October 2007 to February 2009, in the Department of Otorhinolaryngology of SS. Annunziata Hospital, Chieti, Italy. 132 consecutive patients with OME were included in the study. Fluid in the middle ear was assessed for the presence of Helicobacter Pylori through RT-PCR.

RESULTS

132 consecutive patients with OME were included in the study. The patients were between ages 8 and 78 (median 50); 62 were males (47%), 70 were females (53%), and 53 patients had bilateral OME (40%). 185 samples were collected from 132 patients. Of the 185 samples taken from the ear, 21 (11.35%) were not adequate for the correct execution of the DNA extraction procedure. The remaining 167 samples, subjected to RT-PCR, did not show in any case an increase in fluorescence linked to the FAM fluorophore, thus demonstrating the complete absence of Helicobacter Pylori.

CONCLUSION

Based on the results obtained, we can affirm that although a third of the cases of OME is correlated to the presence of reflux, Helicobacter Pylori does not seem to play any role in the pathophysiology of OME as it cannot be found in endo-tympanic exudate.

Association between Helicobacter pylori and otitis media with effusion in children: A systematic review

BACKGROUND

Studies have shown that Helicobacter pylori (H. pylori) infection may be associated with the occurrence of otitis media with effusion (OME) in children.

OBJECTIVE

This is a systematic review of the relevant published literature to explore the relationship between H. pylori infection and OME in children.

METHOD

Articles published before October 30, 2019 in the PubMed, Web of Science, Ovid, the China National Knowledge Infrastructure (CNKI) database, and Wanfang databases were retrieved. Articles were screened based on prespecified inclusion and exclusion criteria. Quality assessment was applied to the included studies. Data in the included studies were extracted and classified for qualitative analysis.

RESULTS

Ten studies, which enrolled a total of 397 cases and 334 controls, were included; all were case-control studies of varying quality. We summarized and compared H. pylori infections in different specimens from pediatric patients with OME. Due to the apparent heterogeneity between the included studies, meta-analysis was not appropriate, hence we carried out only a qualitative analysis.

CONCLUSION

The detection rate of H. pylori in the middle ear, tonsil and gastric juice in children with OME was higher than that in children without OME. There is no clear and reliable conclusion as to whether there is a difference in the detection rate of H. pylori in adenoid specimens of children with or without OME. Eradication of H. pylori may improve symptoms of drug-resistant OME. Nevertheless, more studies of higher quality are needed to improve the conclusions.

Association Between Helicobacter pylori Infection and Otitis Media With Effusion Risk in Children: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the potential correlation between Helicobacter pylori infection and otitis media with effusion (OME) risk in children.

DATA SOURCES

Electronic databases were searched, including Cochrane Library, PubMed, Embase, China Biology Medicine disc, China Science and Technology Journal Database, Wanfang Database, and China National Knowledge Infrastructure Database.

REVIEW METHODS

A systematic review and meta-analysis were conducted with Revman 5.3 software. Combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate infection-disease association.

RESULTS

In total, 11 studies from 9 articles regarding H pylori infection and OME risk were enrolled in this meta-analysis. A significant association between H pylori infection and OME was detected for both adenoid samples from the case group (OR, 2.75; 95% CI, 1.43-5.30; P = .002) and middle ear fluid samples from the case group (OR, 4.45; 95% CI, 2.52-7.88; P < .00001). Subgroup analyses suggested a stronger correlation in African and Asian populations.

CONCLUSION

This study indicated the correlation between H pylori infection and increased risk of OME in children, especially in African and Asian populations. Further well-designed studies regarding the white population are strongly recommended in the future.

Gastroesophageal reflux and respiratory diseases: does a real link exist?

INTRODUCTION

Gastro-esophageal reflux disease (GERD) indicates a gastroesophageal reflux that causes symptoms such as pain, and needs medical therapy, and may result in complications such as erosive esophagitis, aspiration pneumonia. Here, we review if it exists a real link between clinical presentation of some respiratory diseases such as asthma, chronic cough, cystic fibrosis and laryngopharyngitis and GERD.

EVIDENCE ACQUISITION

This review was conducted employing 2 databases: PubMed and Science Direct.

EVIDENCE SYNTHESIS

Asthma may lead to reflux, and reflux could exacerbate asthma or cause asthma-like symptoms. Prevalence of GERD in children with asthma ranged from as low 32% to as high 80%. There are several studies where the use of proton pump inhibitors (PPIs) and histamine H2 receptor antagonists lead to inconclusive results. The relation of chronic unexplained cough to GERD remains controversial in children and pediatric guidelines do not currently recommend empirical GERD treatment trials for pediatric chronic cough. Gastroesophageal reflux is more frequent in patients with cystic fibrosis (CF) than general population. Although PPIs are regularly prescribed in approximately half of the patients with CF, there are no specific guidelines for treatment of reflux in CF and it was shown that chronic treatment with PPIs was correlated to possible increased risk of exacerbations.

CONCLUSIONS

The pathogenesis of GER-related respiratory symptoms is multifactorial. The causal relationship between these two conditions may be difficult to prove also with the aid of supporting tests. Multichannel intraluminal impedance associated with pH-metry (pH/MII) detect all gastroesophageal reflux episodes accompanied with a bolus movement and classify GER episodes according to their content (liquid, gas and mixed), pH value and proximal extension. There are no consistent evidences confirming the validity of medical therapy in reflux with respiratory symptoms.

Is there any association between Helicobacter pylori and otitis media with effusion?

Introduction

It is proposed that Helicobacter pylori can be responsible for the development of otitis media with effusion.

Objective

The aim of this study is to investigate the prevalence of H. pylori in the adenoid tissue and fluid of the middle ear in patients who suffer from adenoid hyperplasia and otitis media with effusion in comparison with those who suffer from adenoid hyperplasia without otitis media with effusion.

Methods

This is a case–control study that was carried out in 50 children of age 2–7 years old who were admitted with adenoid hyperplasia. Patients were divided into case and control groups. The study group included 25 patients with adenoid hyperplasia and otitis media with effusion and the control group included 25 patients with adenoid hyperplasia without otitis media with effusion. The patients in both groups underwent surgical adenoidectomy. For the case group we carried out myringotomy and placement of tympanostomy tube, and fluid samples were collected under sterile conditions. The samples were sent to the laboratory for polymerase chain reactions.

Results

In the case group H. pylori was found to be positive in 18 samples of the middle ear fluid (70%) and in 1 polymerase chain reaction adenoid tissue sample (4%). In the control group H. pylori was positive in 3 samples of adenoid tissues (12%). There was no gender difference.

Conclusion

H. pylori is one of the important bacteria that plays a role in the pathogenesis of otitis media with effusion. Whether adenoid tissue may be a reservoir for H. Pylori is unclear.

The relationship between adenoid hypertrophy and gastroesophageal reflux disease: A meta-analysis

BACKGROUND

Gastroesophageal reflux disease (GERD) is believed to be associated with various manifestations in the otorhinolaryngology and has been found to be an additional risk factor for adenoid hypertrophy, but the causal relation between them is under controversial. We thus performed a meta-analysis to grade the strength of evidence and systematically explore whether adenoid hypertrophy correlates with GERD in the literature.

METHODS

A systematic literature search was performed using Medline via PubMed, Embase, CNKI, and Web of Science. Studies reporting the adenoid hypertrophy and GERD were identified for inclusion.

RESULTS

There were 6 studies that matched the selection criteria, and the total sample size of these studies was 548 cases. We identified a significant relationship between adenoid hypertrophy and GERD, with a pooled odds ratio of 4.12 (95% confidence interval [CI]: 1.32-12.93; P < .001). The results was significant in 24-hour pH monitoring subgroup analysis, with a corresponding value of 8.62 (95% CI: 4.06-18.27, P > .05) under the fixed-effects model. And the results was significant in Helicobacter pylori subgroup analysis, with a corresponding value of 2.39 (95% CI: 0.39-14.55, P < .05) under the random-effects model. Begg tests (P = .73) and Egger tests (P = .76) showed there were no obvious evidence to support publication bias in our study.

CONCLUSION

This meta-analysis provided a strong correlation between adenoid hypertrophy and GERD, the children with adenoid hypertrophy had a higher incidence of GERD than healthy children, but the pathogenesis of GERD in adenoid hypertrophy awaits more investigations and suggests that we should not overlook GERD in clinical practice and an appropriate evaluation for GERD may be needed.

Characterization of the nasopharyngeal and middle ear microbiota in gastroesophageal reflux-prone versus gastroesophageal reflux non-prone children

Otitis media (OM) is one of the most common pediatric infections worldwide, but the complex microbiology associated with OM is poorly understood. Previous studies have shown an association between OM and gastroesophageal reflux (GER) in children. Therefore, in order to bridge the gap in our current understanding of the interaction between GER and OM, we investigated the nasopharyngeal and middle ear microbiota of children suffering from GER-associated OM and OM only, using culture-independent 16S rRNA gene sequencing. Middle ear fluid, nasopharyngeal swabs, and clinical data were collected as part of a prospective pilot study conducted at the Department of Otorhinolaryngology of the Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. A total of 30 children up to 12 years of age who suffered from recurrent acute otitis media (AOM) (5), chronic otitis media with effusion (OME) (23), or both (2), and who were listed for tympanostomy tube placement, were included in the study. Nine children were included in the GER-associated OM cohort and 21 in the OM-only cohort. We found no obvious effect of GER on the nasopharyngeal and middle ear microbiota between the two groups of children. However, our results highlight the need to assess the true role of Alloiococcus spp. and Turicella spp. in children presenting with a high prevalence of recurrent AOM and chronic OME.

Laryngopharyngeal Reflux in Children with Chronic Otitis Media with Effusion

BACKGROUND/AIMS

To evaluate the characteristic properties of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GER) in children with otitis media with effusion (OME) using 24-hour multichannel intraluminal impedance combined with dual-probe (pharyngeal and esophageal) pH-metry.

METHODS

Children aged 7-10 years of age with OME underwent 24-hour multichannel intraluminal impedance pH-metry. The upper pH sensor was situated 1 cm above the upper esophageal sphincter, and the lower pH sensor was placed 3-5 cm above the lower esophageal sphincter. Parents were asked to complete the gastroesophageal reflux assessment of symptoms in a pediatrics questionnaire.

RESULTS

Twenty-eight children were enrolled; LPR was detected in 19 (67.9%) children. The criteria of the LPR diagnosis was the presence of at least one supraesophageal episode with a pH < 5.0 and a change in the pH value measured from the initial level at the upper sensor of > 0.2. In total, 64 episodes were observed. Assessment of all LPR episodes showed the presence of 246 episodes in the entire study. A considerable predominance of weakly acidic episodes (87.8%) was noted; there were 6.5% acidic episodes, and weakly alkaline episodes reached 5.7%. Pathological GER was noted in 10 (35.7%) subjects. Acid GER was detected in 8 children, 2 of whom demonstrated non-acidic reflux. In the LPR-negative patients, no pathological GER was confirmed with the exception of a single case of non-acidic reflux.

CONCLUSIONS

LPR was frequently noted in the group of children with OME, and it might be an important risk factor in this common disease.

Prevalence and characteristics of gastroesophageal reflux in children with otitis media in Isfahan, Iran

BACKGROUND

Otitis media (OM) is the most common cause of childhood hearing loss and reason to visit the pediatrician. Furthermore, gastroesophageal reflux (GER) has been associated with a variety of upper aerodigestive tract symptoms or diseases, such as sinusitis, laryngitis, and otits. The objective of the present study was to determine the frequency of GER in children, aged 3 months to 7 years, with OM.

MATERIALS AND METHODS

This retrospective case-control study was conducted on 50 children with OM and 50 healthy children. Presence of GER as the main variables was diagnosed by clinical examination in all studied children using the questionnaires with 2 age-stratified versions of the pediatric GER disease symptoms for children 2 years old and younger, and children 3-7 years old.

RESULTS

The prevalence of GER in children with OM and controls was 58% and 22% respectively (P = 0.0005). The frequency of irritability, congestion, and feeding complex in children with OM were significantly more than in control groups. Among children with recurrent acute OM (AOM), and chronic serous OM (CSOM) the prevalence of GER was significantly more than controls (61.1%, vs. 22% for AOM, P = 0.004, and 72.7% vs. 22%, P= 0.003). In children with AOM, regurgitation, vomiting, irritability and congestion were significantly higher than controls included. In children with CSOM, regurgitation, vomiting, and congestion were significantly higher than controls.

CONCLUSION

Results show a significant association between GER and OM, AOM and CSOM in children with OM compares to healthy children. This shows that looking for GER in children with OM may help improving treatments outcomes.

Direct molecular detection of a broad range of bacterial and viral organisms and Streptococcus pneumoniae vaccine serotypes in children with otitis media with effusion

Background

Otitis media with effusion (OME) causes significant morbidity in children, but the causes of OME and methods for prevention are unclear. To look for potential infectious etiologies, we performed a pilot study using multiple-target real-time polymerase chain reaction (qPCR) for 27 infectious agents, including nine bacterial organisms and 18 respiratory viruses in middle ear fluids (MEFs) from children with OME. QPCR was also performed for the 13 Streptococcus pneumoniae serotypes contained in the current vaccine.

Results

Forty-eight MEF samples were obtained and qPCR detected bacterial nucleic acid (NA) in 39/48 (81 %) and viral NA in 7/48 (15 %). Alloiococcus otitidis and S. pneumoniae were both detected in 15/48 (31 %) MEFs, followed by M. catarrhalis in 14/48 (29 %), H. influenzae in 5/48 (10 %) and M. pneumoniae in 4/48 (8 %). Rhinoviruses were most common virus type detected, found in 4/48 (8 %) MEFs. Serotypes included in the current 13-serotype vaccine were detected in only 3/15 (20 %) S. pneumoniae qPCR-positive MEFs.

Conclusions

Bacteria may play an important role in OME, since over 80 % of MEFs contained bacterial NA. Further research into the role of A. otitidis in OME will be helpful. Serotypes of S. pneumoniae not included in the current 13-serotype vaccine may be involved in OME. Larger studies of OME S. pneumoniae serotypes are needed to help determine which additional serotypes should be included in future vaccine formulations in order to try to prevent OME.

Can Helicobacter pylori infection influence human reproduction?

Helicobacter pylori (H. pylori) infection could be associated with extra-digestive diseases. Here, we report the evidences concerning the decrease in reproductive potential occurring in individuals infected by H. pylori, especially by strains expressing CagA. This infection is more prevalent in individuals with fertility disorders. Infected women have anti-H. pylori antibodies in cervical mucus and follicular fluid that may decrease sperm motility and cross react immunologically with spermatozoa, conceivably hampering the oocyte/sperm fusion. Infection by CagA positive organisms enhances the risk of preeclampsia, which is a main cause of foetus death. These findings are supported by the results of experimental infections of pregnant mice, which may cause reabsorption of a high number of foetuses and alter the balance between Th1 and Th2 cell response. Infected men have decreased sperm motility, viability and numbers of normally shaped sperm and augmented systemic levels of inflammatory cytokines, such as tumor necrosis factor-α, which may damage spermatozoa. In countries where parasitic infestation is endemic, detrimental effects of infection upon spermatozoa may not occur, because the immune response to parasites could determine a switch from a predominant Th1 type to Th2 type lymphocytes, with production of anti-inflammatory cytokines. In conclusion, the evidences gathered until now should be taken into consideration for future studies aiming to explore the possible role of H. pylori infection on human reproduction.

The Prevalence Rate of Helicobacter pylori Infection in, Chronic Otitis Media With Effusion Patients

Background:

Otitis media with effusion (OME) is a common disease in children. Viral or bacterial infections, allergy, adenoids, functional abnormalities of the Eustachian tube, and gastroesophageal reflux might have a possible role in the pathogenesis of OME. However, the exact pathogenesis of OME is still unsettled.

Objectives:

The purpose of this study was to compare Helicobacter pylori prevalence rates in the nasopharynx of pediatric patients with and without OME.

Patients and Methods:

Eighty-four patients (50 males and 34 females) who were subjected to adenoidectomy and myringotomy were included in the study group. Ninety-one patients (48 males and 43 females) who had only adenoidectomy were selected as the control group. Detection of H. pylori was done by polymerase chain reaction (PCR).

Results:

Adenoid samples were positive for H. pylori in 21 (25%) patients in study group and 18 (19.8%) patients in control group. In the study group, 36 (42.8%) effusion samples (otitis media) of the patients were positive for H. pylori. In an analysis that compared H. pylori–negative and –positive children, the odds ratio (OR) for the occurrence of H. pylori was 1.35 (95% CI, 0.66 - 2.71). The association of age with H. pylori positivity decreased for 1-5 years age group, (1.09; 95% CI, 0.39 – 3.05) but increased for the 6-10 years group (OR, 1.48; 95% CI, 0.61–3.58). Furthermore, the association of sex with H. pylori positivity decreased for the male group (OR, 1.21; 95% CI, 0.50 – 2.91), but increased in the female group (OR, 1.44; 95% CI, 0.51–0.4.05).

Conclusions:

Heavy colonization of H. pylori in adenoid tissue and middle ear might have a role in pathogenesis of this infection. For OME cases resistant to medical treatment, it might be meaningful to evaluate the patient for H. pylori.

Characterization and comparison of bacterial communities in benign vocal fold lesions

BACKGROUND

Benign vocal fold lesions, including cysts, nodules, polyps, and Reinke's edema, are common causes of hoarseness and subsequent voice disorders. Given the prevalence of these lesions, disease etiology and pathophysiology remain unclear and their microbiota has not been studied to date secondary to the paucity of available biopsies for investigation. We sought to characterize and compare the bacterial communities in biopsies of cysts, nodules, polyps, and Reinke's edema collected from patients in Germany and Wisconsin. These samples were then compared to the communities found in healthy saliva and throat samples from the Human Microbiome Project (HMP).

RESULTS

454 pyrosequencing of the V3-V5 regions of the 16S rRNA gene revealed five phyla that explained most of the bacterial diversity, including Firmicutes (73.8%), Proteobacteria (12.7%), Bacteroidetes (9.2%), Actinobacteria (2.1%), and Fusobacteria (1.9%). Every lesion sample, regardless of diagnosis, had operational taxonomic units (OTUs) identified as Streptococcus, with a mean abundance of 68.7%. Most of the lesions, 31 out of 44, were indistinguishable in a principal coordinates analysis (PCoA) due to dominance by OTUs phylogenetically similar to Streptococcus pseudopneumoniae. Thirteen lesions not dominated by S. pseudopneumoniae were more similar to HMP throat and saliva samples, though 12 of them contained Pseudomonas, which was not present in any of the HMP samples. Community structure and abundance could not be correlated with lesion diagnosis or any other documented patient factor, including age, sex, or country of origin.

CONCLUSIONS

Dominance by S. pseudopneumoniae could be a factor in disease etiology, as could the presence of Pseudomonas in some samples. Likewise, decreased diversity, as compared to healthy saliva and throat samples, may be associated with disease, similar to disease models in other mucosal sites.

Prevalence of Helicobacter pylori in adenotonsillar hypertrophy in children

CONCLUSION

Our results encourage the notion that the pharynx could be an extragastric reservoir of Helicobacter pylori (HP). The study confirmed the presence of HP in adenotonsillar tissue in children. It could have importance in the pathophysiology of upper respiratory diseases. However, its precise role in these processes remains unclear and requires further studies.

OBJECTIVE

A prospective study was carried out to evaluate the presence of HP in tonsillar and adenoid tissue in children. The study focused on real-time PCR analyzing CagA and VacA genotypes of HP strains.

METHODS

A total of 37 consecutive pediatric patients with adenotonsillar hypertrophy indicated for surgery were observed in a prospective study. Adenoidectomy and/or tonsillectomy was performed in each patient; 49 specimens were taken, 32 from adenoids and 17 from tonsils. The presence of HP and its genotype were tested in all samples by real-time PCR analysis.

RESULTS

Of 49 samples analyzed, 48 were positive for the presence of HP (98%), so only 1 sample was negative. While the genotype VacAs1bm2 was definitely dominant in adenoid tissue, wider distribution was observed in tonsillar tissue. Cag(+) strains represented one-fifth of all samples (21%).

The Role of Helicobacter pylori in Upper Respiratory System Infections: Is it More Than Colonization?

Helicobacter pylori (HP) is recognized as a common chronic human bacterial infection and is the most common cause of gastritis. Recent studies suggest an increased HP prevalence in patients with various extra-digestive inflammatory diseases. Since many respiratory diseases are characterized by chronic inflammation as well as increased immune response, and HP may enter the nasopharyngeal cavity by gastroesophageal reflux, an association between respiratory disorders and HP infection has been suggested. Several studies discover HP in clinical samples from the patients with upper respiratory system infections. Even some of them revealed a relief after the treatment directed to HP eradication. However some studies do not support this theory and whether this association means a definite proof of a causal relationship between HP and respiratory diseases needs to be clarified. In this study, we aimed to review the reports about the role of HP in upper respiratory system infections.

Role of GERD in children with otitis media with effusion

OBJECTIVES

To establish whether Gastroesophageal reflux disease (GERD) plays a significant role in the etiopathogenesis of otitis media with effusion (OME) patients and to find if there is any association between GERD symptoms and OME. Also, to detect presence of pepsinogen in the middle ear aspirate and to demonstrate pepsinogen band by electrophoresis.

METHODS

This is a prospective study conducted in a tertiary care hospital. Middle ear effusion samples were collected from 32 children undergoing surgery for OME.The samples were measured for pepsinogen level as well as total protein content. Samples were subjected to electrophoresis study by SDS PAGE (Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis).

RESULTS

A total of 21 patients out of 32 were found to have higher pepsinogen level in their middle ear effusion samples than the cut off value of 90 mg/ml.The lack of symptoms associated with GERD among the children in this study corroborates with other similar studies in the world literature. It was also statistically shown that the association between GERD score and pepsinogen level was insignificant (P = 0.512).

CONCLUSIONS

OME appears to be multifactorial disease.GERD may be one of the contributing factors in the etiopathogenisis of OME.

Can Helicobacter pylori cause inflammation in the middle ear?

OBJECTIVES

To investigate whether Helicobacter pylori causes inflammation in the normal middle ear and in the middle ear with effusion.

METHODS

Sixteen adult New Zealand white rabbits were divided into two gropus equally. Group I was representing histamine-induced middle ear inflammation and Group II was representing normal middle ear. While H. pylori was inoculated in the right ears, physiologic saline was inoculated in the left ears of the rabbits in both groups. Results were evaluated clinically, histopathologically and microbiologically. Fisher's exact test was used for statistical analysis.

RESULTS

In Group I, clinical scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Histopathological scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Also, H. pylori was isolated in 6 of the 8 right ears of the rabbits. In Group II, while clinical scores of the inflammation in the right ears scores were higher than the left ears scores at the 7th day, histopathological scores were not significantly different between both ears. Also, no H. pylori was isolated in right ears of the rabbits.

CONCLUSIONS

Effusion in the middle ear induced by histamine is an appropriate medium for H. pylori reproduction and it also aggravates the inflammation process. In contrary, H. pylori did not cause inflammation in the normal middle ear. We suggest that H. pylori does not play a role in the etiology of otitis media with effusion alone, but it contributes to the inflammation process in the presence of an effusion.

Incidence of Helicobacter pylori infection and their clarithromycin-resistant strains in otitis media with effusion regarding phenotypic and genotypic studies

Helicobacter pylori (H. pylori) are pathogenic bacteria that infect a half of the human population, colonize gastric mucosa and can be found in gastric juice. Reflux of gastric juice has been suggested to be associated with glue ear in children. It has been suggested that tonsil and adenoid tissues are potential reservoirs of H. pylori infection. These observations raise the question as to whether H. pylori infection might have a role in otitis media with effusion (OME) in children. The objectives of this research were to evaluate the incidence and possible role of H. pylori in the pathogenesis of OME in children and to evaluate the clarithromycin-resistant strains. Molecular assessment was done to evaluate the culture results vs. molecular study. A total of 60 children, who were prone to ventilation tube insertion, adenoidectomy and/or tonsillectomy were included in the study. The control group consisted of 40 children who underwent adenoidectomy and/or tonsillectomy without the history of OME. Samples of the middle ear fluid and mucosa, adenoid tissue, tonsillar tissue and gastric lavage were cultured and underwent polymerase chain reaction (PCR) analysis then were assembled by using QIAxcel System as capillary electrophoresis for H. pylori detection. There was significant difference between the results of cultures and PCR (P < 0.05). Middle ear fluid culture was positive for H. pylori in 40% of the patients vs. 56.7% PCR results while middle ear mucosa culture was positive in 20% vs. 26.7% PCR results. Gastric lavage culture was positive in 46.6% of the patients and PCR was positive in 63.3% of the patients. Adenoid culture and PCR were positive in 56.3% for each, while tonsil culture was positive in 70% and PCR was positive in 90%. H. pylori presence in the gastric lavage, the tonsillar and adenoid tissues by culture and PCR was significantly more frequent in the study group compared to the control group. The minimum inhibitory concentration (MIC) values of clarithromycin-resistant isolates ranged from 1.5 to 8 μg/ml. This study showed the presence of H. pylori in around 50% of the patients with OME. PCR revealed its sensitivity than culture techniques. The incidence of clarithromycin resistance was found to be high among the isolates (39.6%).

A study to detect Helicobacter pylori in adenotonsillar tissue

We conducted a prospective study to investigate the possibility of Helicobacter pylori colonization on tonsillar and adenoid tissues. Our study group was made up of 84 consecutively presenting children aged 4 to 12 years who had undergone adenotonsillectomy or adenoidectomy with or without ventilation tube insertion. The excised specimens were analyzed by rapid urease testing and histopathologic examination to detect H pylori. Histologic sections were subjected to hematoxylin and eosin staining and Giemsa staining as performed in routine gastric biopsies. We found no H pylori colonization in any specimen. Therefore, we consider the possibility of H pylori colonization of adenotonsillar tissue unlikely, even though the authors of some recent studies have reported such a finding. Other means of detecting possible H pylori colonization in the upper aerodigestive tract rely on invasive biopsy procedures, which are difficult to use in clinical practice. Therefore, on the basis of our findings and our review of the literature, we conclude that looking for H pylori in the upper aerodigestive tract is not only clinically useless, but damaging, as well.

Could Helicobacter pylori play a role in the aetiopathogenesis of tympanosclerosis?

AIM

The aetiology of tympanosclerosis is not yet clear. This prospective, controlled, clinical study investigated the relationship between Helicobacter pylori and tympanosclerosis aetiology.

MATERIALS AND METHODS

The study included 14 patients with tympanosclerosis and 26 with other forms of chronic otitis media. All patients underwent surgery for chronic otitis media. Mucosal biopsies were taken, and examined for H pylori using the Campylobacter-Like Organism (CLO) test.

RESULTS

Tympanoplasty was performed in 29 patients (72.5 per cent), radical mastoidectomy in eight (20 per cent) and myringoplasty in three (7.5 per cent). The presence of H pylori was tested in all tympanosclerosis biopsies, but in only 26.9 per cent of biopsies from other forms of chronic otitis media. A statistically significant difference in H pylori presence was found (p ≤ 0.01).

CONCLUSION

This study represents a preliminary investigation of the association between H pylori and tympanosclerosis development.

Helicobacter pylori and its role in vocal folds' minimal lesions

BACKGROUND

  Chronic laryngitis and/or vocal fold minimal lesions (VFMLs) are common associations with gastro esophageal reflux disease. Helicobacter pylori (HP) is a Gram-negative spiral organism accused of being a common cause of gastritis, gastroesophageal reflux disease and peptic ulcer. HP has been recently isolated from tonsils, adenoids, sinus and middle ear mucosa in patients with chronic sinusitis or chronic middle ear effusion.

OBJECTIVE

  The objective of this study is to assess the presence of HP in VFMLs.

METHODS

  The study included 14 patients with VFMLs [six cases with vocal fold polyps and four cases with vocal fold nodules, and four cases with posterior granulomas; one of them associated with right vocal fold (VF) nodule]; all underwent carbon-13 urea breath test, esophago-gastro-duodenoscopy with gastric biopsy and direct laryngoscopy with microlaryngosurgery to extract the VF lesions. Biopsies were subjected for two tests: detection of the 23S ribosomal RNA gene of HP by real-time polymerase chain reaction (RT-PCR) and immunohistochemical reactions (IHC).

RESULTS

  HP was detected by RT-PCR in 10 of 14 patients with VFML; HP was also detected by IHC in the same number of VFML and gastric mucosa specimens.

CONCLUSION

  HP is a common finding in cases of VFML; its eradication should be considered when dealing with a patient with VFML.

Detection of Helicobacter pylori in adenotonsiller tissue specimens by rapid urease test and polymerase chain reaction

In recent studies, there have been many arguments concerning Helicobacter pylori being reservoir in adenotonsillar tissue. In this study, our objective was to detect whether adenoid and/or tonsillar tissue of patients diagnosed with chronic adenotonsillitis was a reservoir for H. pylori. This study was performed with 47 patients with the diagnosis of chronic tonsillitits and adenoid hypertrophy. Helicobacter pylori was searched by rapid urease test (RUT) and polymerase chain reaction (PCR). Presence of H. pylori glmM gene (formerly named as ureC gene) was tested using ureC and ureC2 primers. Fifty-five specimens used in the study were made up of 35 adenoid and 20 tonsil tissues. Rapid urease test was positive in three (5.5%) specimens. Helicobacter pylori was not detected in any of the patients by PCR. Further studies are needed to clarify the possible role of H. pylori in upper aerodigestive tract diseases such adenotonsillitis.

Does Helicobacter pylori play a role in etiology of nasal polyposis?

OBJECTIVE

Investigation of the possible relation between nasal polyposis (NP) and Helicobacter pylori (HP).

PATIENTS AND METHODS

Biopsy specimens of 25 patients with NP were evaluated. There were 16 men and 9 women enrolled in the study (NP) group. There were 10 men and 4 women in the control group. Campylobacter-like organism (CLO) test, immunohistochemical examination on nasal polyp tissue biopsy specimens and serological analysis were used for detecting HP.

RESULTS

There was only one (4%) positive NP case for CLO test. There were six cases in the study group with positive anti HP IgG test. Two control nasal mucosa were CLO positive. There were three cases in control group with positive anti HP IgG. There were no positive cases with positive anti IgM HP regarding both the study and the control groups. The immunohistochemical examination of the specimens taken from the patients with NP and control patients revealed that all patients were negative for HP. Positive CLO test and serologic test ratios were not statistically significant between NP and control groups.

CONCLUSION

The results of this study did not confirm other investigators. The suggested role of HP in the previous reports regarding NP may demonstrate transient occurrence of HP. It may not be treated as a possible etiological factor in NP.

Does Helicobacter pylori play a role in the development of chronic adenotonsillitis?

OBJECTIVE

Evaluation of the possible relationship between chronic adenotonsillitis and Helicobacter pylori (HP).

PATIENTS AND METHODS

The study was performed prospectively on 91 pediatric patients who underwent tonsillectomy, adenoidectomy or adenotonsillectomy due to chronic tonsillitis and/or adenoiditis. The adenotonsillectomy specimens were examined for HP colonization by rapid urease test (RUT) and immunohistochemical evaluation. Before surgery, anti-HP IgG and IgA antibody titers were detected by enzyme linked immunosorbent assay (ELISA) test in venous blood samples of the patients.

RESULTS

The RUT was positive in only two of the adenoidectomy specimens (2.2%) and in none of the tonsillectomy specimens. A positive result was not detected in any tonsillectomy specimens using immunohistochemical examination. Serum IgG antibody was positive in 21 (23%) patients, IgA antibody was detected in 7 (7.69%) patients and both tests were positive only in 3 (3.29%) patients.

CONCLUSION

The results of this study suggested that HP would not colonize in tonsil tissue of patients with chronic tonsillitis.

Expression of inflammatory mediators in the otitis media induced by Helicobacter pylori antigen in mice

Helicobacter pylori is a Gram-negative bacterium that is recognized as one of the key factors in gastric diseases such as gastritis, peptic ulcer and gastric cancer. Recent studies have shown relationships between H. pylori and extra-digestive diseases, and the presence of H. pylori in the middle ear and upper respiratory tract has been reported. However, the role of H. pylori in middle ear disease remains unclear. The present study demonstrated that H. pylori whole-cell protein directly induces macrophage migration inhibitory factor, macrophage inflammatory protein 2, interleukin 1 beta and tumor necrosis factor alpha in middle ear epithelium in mice, and severe proliferation of inflammatory cells was observed in middle ear cavity inoculated with H. pylori whole-cell protein. In addition, trans-tympanic injection of macrophage migration inhibitory factor up-regulated expression of macrophage inflammatory protein 2 in the middle ear. These findings indicate that H. pylori infection causes immunological inflammation in middle ear epithelium, and H. pylori may play a significant role in otitis media.

A critical evaluation of the evidence on a causal relationship betweenHelicobacter pyloriand otitis media with effusion

Objective:

There is growing interest in the presence ofHelicobacter pyloriin the upper aerodigestive tract, and in the middle ear in patients with otitis media with effusion. Some studies have reported detectingH pyloriin the middle ear, although reports to the contrary exist. In this study, we critically evaluate the evidence for the theory thatH pyloriin the middle ear plays a role in otitis media with effusion.

Material:

We undertook a systematic review of all available studies investigating the presence ofH pyloriin the middle ear of patients with otitis media with effusion. The current literature was critically analysed using the key words and phrases ‘Helicobacter pylori’ ‘otitis media with effusion’, ‘serous otitis media’, ‘glue ear’ and ‘middle ear’. Six original research papers were identified, studying a total of 203 patients and 27 controls; two of these papers were randomised, controlled studies and four were prospective, cohort studies.

Results:

At present, there is poor evidence for the existence ofH pylori-associated otitis media with effusion.

Conclusions:

Further research in the field is needed in order to delineate the presence ofH pyloriand its role in the pathogenesis of otitis media with effusion.

Tonsillar colonization is unlikely to play important role in Helicobacter pylori infection in children

OBJECTIVE

To determine (i) seroprevalence of Helicobacter pylori (HP) infection in children undergoing tonsillectomy, (ii) possible HP colonization on tonsils of children and its importance in HP transmission, and (iii) if four examined socio-economic factors are the risk factors for HP transmission and HP colonization on tonsils in children.

METHODS

Rapid urease test (RUT) of tonsils, and serologic blood tests for HP were performed in 77 children (aged 4-14 years) in Bosnia and Herzegovina (B-H), undergoing tonsillectomy. RUT positive tonsils were cultured for HP. RUT positive children were tested using (13)Carbon-urea breath test ((13)C-UBT). Information about socio-economic potential risk factors was obtained from the parents.

RESULTS

Out of 139 pharyngeal and palatine tonsils, 17 palatine tonsils in 14 children were RUT positive and had negative HP culture. Eight children had positive both RUT and (13)C-UBT. There was no significant difference between children with hypertrophy and those with recurrent tonsillitis comparing their serologic tests results. There was no significant difference between seronegative (n=61) and seropositive (n=16) children comparing their age, sex, parental education level, owning a family courtyard, attending a children's collective, and owning a pet cat.

CONCLUSIONS

The results in this prospective study do not support the notion that tonsils are an important reservoir for HP transmission in children in B-H. The examined socio-economic factors did not enhance HP seropositivity rate in children.

Helicobacter pylori and extragastric diseases

Since the discovery of Helicobacter pylori, several studies have investigated the hypothetical role of this bacterium in various extragastric diseases, e.g. ischemic heart disease, idiopathic thrombocytopenic purpura, iron-deficiency anaemia, and other disorders. The majority of these studies are epidemiological or eradication trials, but there are also case reports and in-vitro studies. Idiopathic thromobocytopenic purpura is the disease that shows the strongest link with H. pylori infection. There is also evidence of a role of CagA-positive H. pylori infection in iron-deficiency anaemia and ischemic heart disease. The association between H. pylori infection and other extragastric diseases remains controversial, being mostly supported by 'case reports', small pilot studies, or just in-vitro data. Further studies are needed to identify whether there is any pathological implication for H. pylori infection in these diseases.

Extragastric diseases associated with Helicobacter pylori infection

This paper critically reviews the current literature on extragastric diseases associated with Helicobacter pylori infection, with an emphasis on methodologic issues that complicate interpretation of study findings. This review reveals common study limitations and overall uncertainty that H. pylori infection plays a role in extragastric diseases, although such a role has not been clearly ruled out for specific diseases of relevance. Evidence suggests that anti-H. pylori therapy may lead to improvement of a few extragastric diseases, in particular, idiopathic thrombocytopenic purpura, iron deficiency anemia, and chronic idiopathic urticaria, but the data from randomized controlled trials are insufficient to confirm this beneficial effect; if the benefit of anti-H. pylori therapy for specific diseases is real, it is not clear if it results from removing H. pylori-specific injurious effects, eliminating some other infectious pathogen, or reducing the total infectious burden.

Extragastric manifestations of Helicobacter pylori infection--other Helicobacter species

Recent studies have indicated a strong link between Helicobacter pylori and idiopathic thrombocytopenic purpura and iron deficiency anemia. Interesting results have also been obtained for ischemic heart disease, though most putative associations between H. pylori infection and extragastric disease remain speculative. With regard to other Helicobacter species, Helicobacter felis has been shown to play a role in gastric carcinogenesis in mouse models. An increased susceptibility to cholesterol gallstone formation has been described in animals fed a lithogenic diet and infected with Helicobacter bilis, or co-infected with Helicobacter hepaticus and Helicobacter rodentium. Finally, enterohepatic Helicobacter species have also been exploited to better understand inflammatory bowel disease.

Chronic otitis media with effusion and Helicobacter pylori

OBJECTIVE

The aim of this study is to investigate the presence of Helicobacter pylori (HP) in the middle ear effusion by Campylobacter-like organism (CLO) test and whether it has a role in the ethiopathogenesis of chronic otitis media with effusion (OME).

STUDY DESIGN

A prospective randomized and controlled study.

METHODS

This study was performed with 45 patients with the diagnosis of chronic OME and adenoid hypertrophy, between the ages 3 and 13 (median 6). Thirty patients constituted the study group (18 male (60%) and 12 (40%) female). Adenoidectomy with myringotomy with ventilation tube insertion were performed to this group. Middle ear effusion and adenoid tissue pieces were collected and H. pylori presence was investigated by "CLO" testing. Fifteen patients of the matching age group (9 male (66.7%) and 6 (33.3%) female) constituted the control group to whom adenoidectomy with myringotomy were performed but no middle ear effusion could be determined (empty myringotomy patients). The wash out liquid of middle ear and pieces of adenoid tissue samples were also collected from the control group. By using CLO testing, the presence of H. pylori was investigated in the adenoid tissues and middle ear of the empty myringotomy patients.

RESULTS

In 20 (66.6%) patients of the study group, CLO testing was positive in the middle ear effusions. None of the patients demonstrated positive CLO test in the wash out liquid of middle ear. There was significant difference of positive CLO testing in the middle ear effusions of two groups (p<0.001).

CONCLUSIONS

These findings showed us that presence of HP in the middle ear effusion using CLO testing and this may be responsible for the ethiopathogenesis of chronic OME.