A critical evaluation of the evidence on a causal relationship between Helicobacter pylori and otitis media with effusion

Identifying the Microbiome of the Adenoid Surface of Children Suffering from Otitis Media with Effusion and Children without Middle Ear Effusion Using 16S rRNA Genetic Sequencing

BACKGROUND

The upper respiratory tract harbors diverse communities of commensal, symbiotic, and pathogenic organisms, originating from both the oral and nasopharyngeal microbiota. Among the primary sites of microbial colonization in the upper airways are the adenoids. Alterations in the adenoid microbiota have been implicated in the development of various conditions, including secretory otitis media.

AIM

This study aims to employ 16S rRNA genetic sequencing to identify the most common bacteria present on the surface of adenoids in children with otitis media with effusion and compare them with children without pathologies in the tympanic cavity. Additionally, we seek to determine and compare the bacterial diversity in these two study groups.

MATERIALS AND METHODS

A total of nineteen samples from the adenoid surfaces were collected, comprising two groups: thirteen samples from children without middle ear effusion and six samples from children with secretory otitis media. The libraries of the V3-V4 hypervariable region of the bacterial 16S rRNA gene was made and sequenced using MiSeq platform.

RESULTS

The most prevalent phyla observed in both groups were Proteobacteria, Firmicutes, and Bacteroidetes. The most common bacterial genera identified in both groups were Haemophilus, Streptococcus, Moraxella, Fusobacterium, and Bordetella, with Fusobacterium and Moraxella being more prevalent in the groups that had no middle ear effusion, while Haemophulus and Streptococcus were more prevalent in the otitis media with effusion group, although not in a statistically significant way. Statistical analysis shows a trend towards bacterial composition and beta diversity being similar between the study groups; however, due to the limited sample size and unevenness between groups, we should approach this data with caution.

CONCLUSION

The lack of prolific difference in bacterial composition between the study groups suggests that the role of the adenoid microbiome in the development of otitis media with effusion may be less significant.

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.

Effects of Helicobacter pylori infection in gastrointestinal tract malignant diseases: From the oral cavity to rectum

Helicobacter pylori (H. pylori) has infected approximately fifty percent of humans for a long period of time. However, improvements in the public health environment have led to a decreased chance of H. pylori infection. However, a high infection rate is noted in populations with a high incidence rate of gastric cancer (GC). The worldwide fraction of GC attributable to H. pylori is greater than 85%, and a high H. pylori prevalence is noted in gastric mucosa-associated lymphoid tissue lymphoma patients. These results indicate that the majority of GC cases can be prevented if H. pylori infection is eliminated. Because H. pylori exhibits oral-oral or fecal-oral transmission, the relationship between this microorganism and other digestive tract malignant diseases has also attracted attention. This review article provides an overview of H. pylori and the condition of the whole gastrointestinal tract environment to further understand the correlation between the pathogen and the host, thus allowing improved realization of disease presentation.

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.

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.

Presence of Helicobacter Pylori in the Stomach and Laryngeal Mucosal Linings in Patients with Laryngeal Cancer

SUMMARY – Helicobacter (H.) pylori is the cause of one of the most common chronic bacterial infections in humans. Risk factors for the development of laryngeal cancer are cigarette smoke, alcohol, and human papillomavirus. Several papers report on H. pylori isolated in tooth plaque, saliva, middle ear and sinuses. Many articles describe the presence of H. pylori in laryngeal cancer cases, however, without noting the possible source of infection, i.e. stomach or oral cavity. The aim of this study was to determine which patients and to what extent simultaneously developed H. pylori colonization in the stomach and the larynx. Prospective examinations were performed in 51 patients with laryngeal squamous cell carcinoma. The study group included patients with laryngeal squamous cell carcinoma histopathologically confirmed by two independent pathologists. The patients underwent fiber esophagogastroduodenoscopy with tumor tissue biopsy. Laryngeal and gastric biopsies were examined by histologic staining technique for histopathologic detection of H. pylori and with DNA analyses using the standardized fluorescent ABI Helicobacter plus-minus PCR assay. Laryngeal carcinoma patients showed positive H. pylori test results simultaneously in the laryngeal and stomach areas, implying H. pylori transmission from the stomach to the laryngeal area. In addition, H. pylori positive test results along with negative H. pylori results in the stomach region were also recorded, suggesting a possible bacteria migration from the oral cavity. In conclusion, H. pylori was found in the area of laryngeal carcinoma, and its migration appeared likely to occur both upwards (from the stomach to the mouth) and downwards (from the oral cavity to the stomach).

Otitis Media with Effusion and Helicobacter pylori

Previous studies reported the presence of Helicobacter pylori in middle ear fluid and raised a possible causal role of this bacterium in otitis media with effusion (OME). We investigated 48 children with OME (age, 7 months to 12 years) seen in New Orleans, Louisiana, and found no evidence of H pylori presence in any middle ear fluid specimen by amplification of the 16S rRNA gene. One child had H pylori detected in a stool specimen, in accordance with the low prevalence in our population. While H pylori may be significant in other countries, these findings do not support a role for H pylori in OME in our pediatric population in the United States.

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.

Helicobacter pylori detection and clinical symptomatology of gastroesophageal reflux disease in pediatric patients with otitis media with effusion

OBJECTIVES

The study aimed to demonstrate Helicobacter pylori presence in otitis media with effusion (OME) and its association with symptomatology of gastroesophageal reflux disease (GERD).

METHODS

In a cohort study, 69 effusions were collected during tympanostomy tube insertion for H. pylori detection using PCR and ELISA. Validated questionnaires were performed according to age for clinical diagnosis of GERD; chi-square ×2 statistical analysis was made.

RESULTS

Eight of the 69 ear effusions (5.7%) were positive for H. pylori detection using ELISA. Two patients (2.9%) had positive results for H. pylori detection using ELISA and PCR. These eight patients had positive results too in GERD questionnaires. None of the patients with negative/suspect questionnaires had positive results for H. pylori. We found statistical association between the results of ELISA, PCR and questionnaires (×2, p = 0.001).

CONCLUSIONS

The H. pylori presence in effusions varies widely, in our population the frequency was lower than other reports. We found strong association between H. pylori in effusions and positive GERD questionnaires. The bacterium role in OME chronicity is not clear, but this study supports the GERD participation in OME pathogenesis.

Aetiology and pathology of otitis media with effusion in adult life

OBJECTIVES

To gather and analyse information concerning the aetiology and pathology of otitis media with effusion in adults.

METHOD

A review of the English language literature from 1970 to the present was conducted.

RESULTS

The available evidence suggests that otitis media with effusion in adult life is best viewed as a syndrome with a number of causes, including: infiltration of the eustachian tube by nasopharyngeal carcinoma and other local malignancies; changes in the middle ear and eustachian tube induced by radiotherapy; and systemic disease.

CONCLUSION

There is now a body of evidence specifically related to the aetiology and pathology of otitis media with effusion in adult life. However, further research is required to fill in the gaps in our knowledge and understanding of this condition.

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.

Helicobacter pylori infection of the larynx may be an emerging risk factor for laryngeal squamous cell carcinoma

INTRODUCTION

Several studies have implicated Helicobacter pylori as a risk factor in laryngeal cancer, but other studies disagree. It is fundamental that the relationship between Helicobacter pylori and laryngeal cancer be verified in order to provide evidence of ways to prevent the initiation and development of this carcinoma.

MATERIALS AND METHODS

In total, 81 patients with laryngeal squamous cell carcinoma and 75 control subjects were enrolled in a case-control study. Semi-nested polymerase chain reaction techniques were applied to detect Helicobacter pylori in the laryngeal mucosa and enzyme-linked immunosorbent assays were used to detect serum antibodies against Helicobacter pylori. Risk factors associated with laryngeal carcinoma were analyzed using logistic regression models.

RESULTS

The presence of Helicobacter pylori in the larynx was higher in patients with laryngeal cancer than in control subjects (71.6 vs. 25.3 %, p < 0.001). Among patients with laryngeal carcinoma, rates of Helicobacter pylori infection were higher in normal laryngeal tissues than in tumor tissues. After adjusting for confounding factors, regression analysis indicated that the microbe was an independent risk factor for laryngeal cancer (OR = 7.15, 95 % CI [3.29, 15.53], p < 0.001).

CONCLUSIONS

This study suggests that Helicobacter pylori is present in the mucosa of the larynx. The microorganism may be an independent risk factor for laryngeal squamous cell carcinoma. The laryngeal mucosa thus provides a reservoir for the bacteria possibly, and is a likely staging place for its transmission to other areas.

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%).

Signaling endosomes and growth cone motility in axon regeneration

During development and regeneration, growth cones guide neurites to their targets by altering their motility in response to extracellular guidance cues. One class of cues critical to nervous system development is the neurotrophins. Neurotrophin binding to their cognate receptors stimulates their endocytosis into signaling endosomes. Current data indicate that the spatiotemporal localization of signaling endosomes can direct diverse processes regulating cell motility, including membrane trafficking, cytoskeletal remodeling, adhesion dynamics, and local translation. Recent experiments manipulating signaling endosome localization in neuronal growth cones support these views and place the neurotrophin signaling endosome in a central role regulating growth cone motility during axon growth and regeneration.

Helicobacters and extragastric diseases

For two decades, Helicobacter pylori has been considered as the culprit in many extragastric manifestations. However, for several of these supposed associations the hypothesis of an etiological role has not yet been fully investigated. This may be due to a series of factors linked to the epidemiological features of the studies and to the diseases investigated. This review attempts to highlight the main reported associations of H. pylori with extragastric manifestations during the last year. The most convincing data arise in the field of idiopathic thrombocytopenic purpura (ITP) and sideropenic anemia. Long-term follow-up studies have shown that 50% of subjects with ITP maintain a hematological response after H. pylori eradication. There is also growing evidence of the role of H. pylori in other diseases, including ischemic heart disease even though results are not conclusive.