Effects of Qing Qiao Capsule in the treatment of chronic secretory otitis media and the levels of serum inflammatory factors

To explore the effects of Qing Qiao Capsule in the treatment of chronic secretory otitis media and the levels of serum inflammatory factors, a total of 50 chronic secretory otitis media patients in the control group were subjected to caefaclor capsule, while the total of 50 cases in the observation group were treated with Qing Qiao Capsule. The traditional Chinese medicine (TCM) syndrome scores, therapeutic effects, and the levels of inflammatory factors were evaluated. After treatment, the scores of deafness, hearing loss, dizziness, soreness and weakness of the waist and knees, and fever is hens in palms and soles were significantly decreased in both groups (all P value <0.05). However, each score in the observation group was markedly less than that of the control group (all P value <0.05). Moreover, the C-reactive protein (CRP), procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) levels measured after treatment were significantly lowered than those before treatment (all P value <0.05). Also, the levels of CRP, PCT and TNF-α in the observation group were obviously less than that of the control group (all P value <0.05). And the total therapeutic efficacy of the observation group was significantly higher than that of the control group (P<0.05). But no significant difference was observed in the rates of adverse reactions between both groups (P>0.05). Application of Qing Qiao Capsule in the treatment of chronic secretory otitis media yields better results, lowers TCM syndrome scores, and alleviates the body's inflammatory response, which is a safe drug in clinical use.

Compound shuanghua tablets combined with Western medicine on serum and secretion inflammatory factors in patients with acute secretory otitis media caused by swimming

To observe and analyze the effect of compound shuanghua tablets combined with western medicine on serum and secretion inflammatory factors in patients with acute secretory otitis media caused by swimming. The 140 patients who had been treated in our hospital for acute secretory otitis media were selected as research objects, all of which were caused by swimming. The patients were divided into two groups, namely the control group accepting routine western drug therapy and the research group accepting compound shuanghua tablets combined with western drug therapy, each group contains 70 patients. The therapeutic effect of patients in two groups were observed and compared. Through observation, the levels of tumor necrosis factor, interleukin-6 and interleukin-10 were found to be significantly improved in the research group compared with the control group, and the intergroup difference was of statistical significance, p<0.05; The overall treatment efficiency of the research group was significantly higher than that of the control group, with statistical significance, p<0.05. For patients with acute secretory otitis media caused by swimming, the compound shuanghua tablets combined with Western medicine treatment can not only actively reduce various inflammatory factors in middle ear effusion, but also significantly improve the overall treatment efficiency.

Clinical role of vitamin D in prognosis of otitis media with effusion

OBJECTIVE

To investigate the clinical role of Vitamin D in prognosis of Otitis media with effusion.

METHODS

This prospective-controlled study was conducted at otolaryngology department in Duzce University, Turkey. The study group comprised children who were diagnosed with Otitis media with effusion between September 2016 and February 2017. Control group was conducted with children underwent circumcision or inguinal hernia repair operations that confirmed with ENT examination they do not have any sign of otitis media. After 3 months of follow-up without any treatment, unresolved cases who were accepted as chronic otitis media with effusion were operated under general anesthesia for ventilation tube application. Study and control groups were assessed depending on the serum 25(OH)Vitamin D levels at the end of 3 months; < 15 ng/mL was accepted as vitamin D deficiency. The results were compared with the control group in terms of vitamin D levels. Also, subgroup analysis was performed addressing to the complete recovery otitis media with effusion and chronic otitis media with effusion.

RESULTS

One-hundred-seventy-four children with otitis media with effusion and 80 control patients were included to the study. One-hundred-eight (62%) out of 174 patients with otitis media with effusion was completely recovered after a 3-months follow up. Of those 66 out of 174 children, they had persistent diseases, underwent ventilation tube insertion after a 3-months follow-up. The mean 25(OH)Vitamin D level was 18.98 ± 10.60 in otitis media with effusion group and 28.07 ± 14.10 in control group and the difference was statistically significant between the study and control group (p < 0.001). Vitamin D deficiency was observed in 33 out of 66 patients (50.0%) in chronic otitis media with effusion group whilst 35 out of 108 patients (32.4%) in complete recovery otitis media with effusion group (p = 0.021). The rate of 25(OH)Vitamin D deficiency was 25% in control group which was statistically different from chronic otitis media with effusion and recovery chronic otitis media with effusion groups (p = 0.006).

CONCLUSIONS

This study not only shows the relationship between Vitamin D and otitis media with effusion development, but also demonstrates the effects of Vitamin D on otitis media with effusion prognosis. There is a significant association between 25(OH)Vitamin D deficiency and follow-up outcomes of otitis media with effusion.

Studying the Serum as Well as Serous Level of IL-17 and IL-23 in Patients with Serous Otitis Media

Serous otitis media with effusion (OME) is a middle ear inflammatory response to allergens and microbes which stimulate leukocytes to produce different inflammatory mediators after obstruction of Eustachian tube. Here, we investigated the levels of these mediators, IL-17 and IL-23, in serum and middle ear fluids of children with OME. 75 patients with otitis media and 75 age and sex-matched healthy controls were enrolled in this study. IL-17 and IL-23 levels in serous secretion of the patients and their serum levels were measured in both groups by ELISA. Serum IL-17 levels were significantly higher in the patients than controls (p=0.001). There was no significant difference between serum IL-23 levels in patients and controls. Patients' serous levels of both cytokines of IL-17 and IL-23 were higher than those in serum according to different parameters of sex, age, and duration of the disease. This study shows an elevated presence of IL-17 and IL-23, as pro inflammatory cytokines, in OME. These finding may represent the contribution of such cytokines in the pathogenesis of OME. Blocking such molecules may yield new non-surgical therapeutics.

Antigen-specific IgE in middle ear effusion of patients with eosinophilic otitis media

BACKGROUND

Eosinophilic otitis media (EOM) is an intractable otitis media characterized by a highly viscous effusion that contains eosinophils. We previously reported that high levels of IgE were detected in middle ear effusion (MEE) of patients with EOM.

OBJECTIVE

To examine antigen-specific IgE in MEE of patients with EOM to clarify the pathogenesis of EOM.

METHODS

Twenty-six patients with EOM associated with bronchial asthma were included in this study. Antigen-specific IgE against inhalant and bacterial antigens were measured in the serum and MEE of these patients.

RESULTS

In patients with EOM, 1 or more antigen-specific IgEs were detected from the MEE of 16 of 26 patients (62%), whereas 1 of 9 control patients (11%) had antigen-specific IgE (P < .01). Total serum IgE concentrations were not different between the groups who tested positive (16 patients) and negative (10 patients) for antigen-specific IgE. None of the fungi-specific IgEs were detected in serum even though 11 patients tested positive for 1 or more fungal antigens detected in MEE. The severity score of EOM in the antigen-specific IgE-positive group was significantly higher than that in the antigen-specific IgE-negative group (P < .05).

CONCLUSION

Antigen-specific IgE against inhalant and bacterial antigens may be locally produced in the middle ear mucosa in patients with EOM. In particular, local sensitization against fungi together with Staphylococcus aureus could result in local IgE production in the middle ear and may be responsible for the severity of EOM.

Effect of omalizumab on biomarkers in middle ear effusion in patients with eosinophilic otitis media

CONCLUSIONS

Eosinophil cationic protein (ECP) concentrations in middle ear effusion (MEE) in patients with eosinophilic otitis media (EOM) were significantly decreased at 3 months after the administration of omalizumab from the baseline level (p < 0.05). This study provides new evidence that omalizumab reduces eosinophilic inflammation in the middle ear and that the reduction of ECP may not be caused by suppression of interleukin (IL)-5 production in the middle ear mucosa.

OBJECTIVE

EOM is an intractable otitis media characterized by a highly viscous effusion containing eosinophils. We recently reported that anti-IgE therapy using omalizumab was efficacious in the treatment of EOM. To clarify the underlying mechanism, we determined changes in biomarkers in MEE related to eosinophilic inflammation after therapy.

METHODS

Nine patients with EOM received the anti-IgE agent omalizumab for 3 months. Among them, five patients continued anti-IgE therapy for longer than 1 year. Eight EOM patients without administration of omalizumab were also included in the study as controls. The concentrations of eosinophilic inflammatory markers such as ECP, IgE, IL-4, and IL-5 in MEE were measured before and after the administration of omalizumab.

RESULTS

After 3 months of omalizumab therapy, the ECP concentration in MEE was significantly reduced from the baseline level (p < 0.05), while no significant change of ECP in the serum was observed. The concentrations of IL-4 and IL-5 in MEE showed no significant change before and after the therapy in EOM patients treated with omalizumab.

[Expression and significance of IFN-γ and IL-4 in the effusion and peripheral blood of chronic otitis media with effusion patients]

OBJECTIVE

To explore the shift of Th2/Th1 type cytokine profiles in middle ear and peripheral blood of chronic otitis media with effusion (COME) patients.

METHODS

Middle ear effusions (MEEs) and peripheral bloods were collected from 30 COME patients between April 2011 and July 2012 at Department of Otolaryngology, Beijing Tongren Hospital, Capital Medical University. Peripheral blood samples were collected from 20 healthy controls. The expressions of IFN-γ (Th1 cytokine) and IL-4 (Th2 cytokine) in peripheral blood and middle ear fluid were assessed by flow cytometry and cytometric bead array. The expression levels of cytokines in peripheral blood were compared between patient and control groups. Moreover, the levels of cytokines in the Middle ear fluid and the supernatant of COME patients were also compared.

RESULTS

Compared to the control group, the level of IL-4 in peripheral blood of COME patients significantly increased (0.7% ± 0.8% vs 2.4% ± 4.5%, P < 0.05) . The ratio of IFN-γ positive cells/IL-4 positive cells was significantly lower in peripheral blood of COME patients than that of control group (17 ± 13 vs 35 ± 19, P < 0.05) . However, the level of IFN-γ showed no significant difference between two groups (12% ± 8% vs 13% ± 8%, P > 0.05) . The levels of IL-4 and IFN-γ in middle ear fluid and the supernatant of the case group showed no significant difference.

CONCLUSIONS

COME may be a Th2 predominant disease. Th1/Th2 imbalance is probably involved in the pathogenesis of COME. The role of the allergic reaction in middle ear microenvironment remains uncertain.

Nitric oxide synthase activity and nitric oxide level in erythrocytes of guinea pigs with experimental otitis media with effusion

Free radicals have been implicated in the pathogenesis of an increasing number of disease and inflammatory states. They may cause cell and tissue damage by chemical modification of proteins, carbohydrates, nucleotides and lipids. Under physiological conditions free radicals are parts of normal regulatory circuits and are neutralized by antioxidants. Infections are one cause of increased free radicals production. The aim of our study was to assess whether increased oxidative stress is reflected by erythrocyte nitric oxide synthase activity and nitric oxide levels in guinea pigs with experimental otitis media with effusion (n = 6) and in a control group (n = 6). Erythrocyte nitric oxide synthase activity and nitric oxide levels were measured in both groups. The nitric oxide synthase activity and nitric oxide level in the experimental otitis media with effusion were significantly higher than those of the control group. There was a significant positive correlation between the nitric oxide synthase activity and nitric oxide in the experimental otitis media with effusion group. Thus, increased nitric oxide levels may play an important role in cell and tissue damage due to experimental otitis media with effusion.

Effect of melatonin on lipid peroxidation, glutathione and glutathione-dependent enzyme activities in experimental otitis media with effusion in guinea pigs

Melatonin plays a role in the prevention of oxidative damage. In the present study, we investigated whether the increased oxidative stress in experimental otitis media with effusion (OME) induced by histamine is reflected in erythrocytes and middle ear effusion fluid. Lipid peroxidation in effusion fluid was measured to determine the effects of melatonin on oxidative stress. Erythrocyte and middle ear effusion malondialdehyde (MDA) levels, erythrocyte glutathione (GSH) levels and glutathione peroxidase (GPx), glutathione reductase (GRd) and glutathione-S-transferase (GST) activities were measured in three groups of six guinea pigs each at 3 hr after the injection of 0.1 mL of histamine (or saline) into the middle ear. In erythrocyte and middle ear effusion samples, MDA levels showed a significant increase in guinea pigs with experimental OME group when compared with the control animals. Erythrocyte GPx, GST, GRd activities and GSH levels significantly reduced in experimental OME guinea pigs when compared with the control and melatonin-treated animals. Erythrocyte GPx activity also significantly increased after melatonin treatment when compared with the control group. These findings suggest that reactive oxygen species play a role in histamine-induced OME. Pretreatment with melatonin increases antioxidant enzyme activities and reduced formation of MDA, an indicator of lipid peroxidation, in histamine-induced OME.

Lymphocyte subpopulations in middle ear effusions: flow cytometry analysis

OBJECTIVE

The aim of this study was to identify lymphocyte subpopulations in middle ear effusions, peripheral blood, and adenoids in children suffering from otitis media with effusion.

SETTING

Tertiary referral center.

PATIENTS

Thirty-three children (55 ears) undergoing myringotomy for otitis media with effusion.

METHODS

CD3, CD4, CD8, CD19, and natural killer cell populations were investigated in middle ear effusion, peripheral blood, and adenoids using a three-color monoclonal antibody and flow cytometry method for quantitative estimation.

RESULTS

T cells (CD3) are dominating lymphocytes in middle ear effusion. Among T lymphocytes, the majority are those of the helper type (CD4). The dominating isoform among CD4 lymphocytes are memory cells (CD4CD45RO); among CD8 lymphocytes, naive cells (CD8CD45RA). The percentage of CD4 cells, CD8 cells, and the CD4/CD8 ratio was significantly higher in middle ear effusions than in blood. The percentage of memory CD4 lymphocytes and naive CD8 lymphocytes was significantly lower in the middle ear effusion. Lymphocyte subsets were compared between 22 pairs of effusions from each patient. The percentage of each type of cell did not differ significantly.

CONCLUSION

The results of this study indicate local regulation of the lymphocyte profile in middle ear effusions and the same phase of immune response in two ears of the same patient.

The role of allergy in the etiology of otitis media with effusion; immune system and cytokines

OBJECTIVES

Otitis media with effusion (OME) is one of the major causes of hearing loss in childhood. In this study, the role and the importance of allergy in the etiology of OME was evaluated with reference to the immune system and the cytokines.

PATIENTS AND METHODS

Seventy-eight ears of 59 patients who had undergone myringotomy with the diagnosis of OME were included in this study. Serum samples of 26 healthy children who were in the same age group and were living in the same region under similar socioeconomic circumstances were examined as the control group.

RESULTS

Interferon (IFN)-gamma levels were significantly lower and IL-4 and IgE levels were significantly higher in the serum samples of the patient group when compared with those of the control group (p<0.05). A positive correlation was found between IL-4 and IgE in the serum samples of patients (p<0.01). However, there were negative correlations between IFN-gamma and both IgE and IL-4 levels, that were not statistically significant.

CONCLUSION

T-helper polarization suggests that allergy may have a role in the etiology of OME. Therefore, it should be kept in mind in the treatment of OME.

[Determination of platelet activating factor in middle ear effusion of patients with secretory oitits media]

OBJECTIVE

To study the role of platelet activating factor (PAF) in the pathogenesis of secretory otitis media (SOM).

METHOD

The content of PAF in blood plasma and middle ear effusion(MEE) were measured in 56(68years) patients with secretory otitis media and in 40 normal subjects respectively by RP-HPLC.

RESULT

The concentration of PAF in MEE was remarkably higher than those in blood plasma (P < 0.01). The concentration of PAF in blood plasma in the SOM group was higher than those in the normal control group(P < 0.05). The concentration of PAF of MEE in the mucous fluid group was higher than those in the serous fluid group(P < 0.01).

CONCLUSION

PAF might be an important mediator in MEE of SOM, it might be closely related to the persistence of SOM, and might play an important role in the pathogenesis of SOM.

Penetration of cefprozil to middle ear effusion in children with chronic otitis media with effusion

BACKGROUND

Because of chronic otitis media with effusion (COME) demonstrates pathogenic bacteria, treatment with appropriate antibiotic is reasonable.

OBJECTIVE

We determined the penetration of cefprozil into the middle ear effusion (MEE) in children with COME.

MATERIALS AND METHODS

25 patients 2-13 years of age with COME were eligible for study. After the single dose of 15 mg/kg patients were assigned to have MEE, and serum samples were obtained during ventilation tube insertion at 0.5, 2, 3, 5, or 6 h after administration of the dose. The concentration of cefprozil was measured using validated high performance liquid chromatography method.

RESULTS

The mean concentrations of cefprozil in the MEE ranged from 0.4 to 4.4 microg/ml. The penetration into MEE was rapid and effective. Cefprozil in the MEE was maintained at a greater level than MIC 90 in S. pneumoniae for at least 6 h after administration of 15 mg/kg.

CONCLUSION

Cefprozil penetrated well into the MEE in children with COME.

Systemic inflammatory responses in children with acute otitis media due to Streptococcus pneumoniae and the impact of treatment with clarithromycin

This pilot study was designed to determine the serum cytokine profile of acute otitis media (AOM) due to Streptococcus pneumoniae and the impact of clarithromycin (Abbott Laboratories, Inc). Serum levels of interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF-alpha), IL-6, and IL-8 were measured at diagnosis and 3 to 5 days after start of antibiotic treatment in 10 patients (mean age, 18.3 +/- 13.9 months) who had middle ear fluid culture positive for S. pneumoniae. The mean concentrations of all cytokines were elevated at diagnosis of AOM compared to levels in healthy controls, yet only IL-6 reached statistical significance (P = 0.05). IL-6 showed a statistically significant decrease in mean serum concentration at visit 2 (P = 0.03). IL-8 displayed a similar pattern to IL-6, but the difference between samples from day 1 and day 2 did not reach statistical significance. The cytokines IL-1 beta and TNF-alpha appear to be elevated in the serum of patients with S. pneumoniae AOM, but there was no significant change between mean serum levels obtained pre- and postinitiation of antibiotic treatment in the time frame studied. The results suggest a systemic inflammatory response as evidenced by increased IL-6. A significant decrease of IL-6 and improvement of clinical symptoms were observed. Determining cytokine levels, especially IL-6, in AOM could offer a powerful tool for objective assessment of response to treatment, minimizing unnecessary treatment of asymptomatic children who may still have some otoscopic findings suggestive of AOM at follow-up visits.

IL-5 and eotaxin levels in middle ear effusion and blood from asthmatics with otitis media with effusion

OBJECTIVE

The purpose of this study was to evaluate eosinophil infiltration as well as IL-5 and eotaxin levels in middle ear effusion (MEE) and blood from otitis media with effusion (OME) patients with asthma and to compare the findings with those from OME patients without asthma (control group).

MATERIAL AND METHODS

Levels of IL-5 and eotaxin in MEE and blood were measured by means of enzyme-linked immunosorbent assay.

RESULTS

5 levels in MEE were significantly higher than those in blood in both groups of patients and in OME patients with asthma than in the control group. In addition, in OME patients with asthma, there was a significant correlation between the percentage of eosinophils and IL-5 levels in MEE. Eotaxin levels in blood were significantly higher than those in MEE in both groups of patients and in OME patients with asthma than in the control group. In addition, in OME patients with asthma, the percentage of eosinophils and eotaxin levels in blood tended to correlate, but did not reach statistical significance.

CONCLUSION

These data suggest that, in OME patients with asthma, eosinophilia in MEE depends more on IL-5 than on eotaxin, and that eotaxin may play an important role in the mobilization of eosinophils from the bone marrow into the blood.

Blood group in otitis media with effusion

The aim of the present study was to assess whether blood group ABO is a risk factor for otitis media with effusion (OME). In a screening program 889 children were studied with pneumatic otoscopy, tuning fork tests, audiometry, impedance measures and blood group tests. Among these children, there were 51 children with OME at the time of examination (5.7%), and 838 healthy children. Multivariate logistic regression risk for OME was compared between children with different blood groups, taking sociodemographic and history-related risk factors into account. Blood group and OME were found to be statistically related. Considering children of blood group A as a reference, children with blood group O had a statistically significant lower risk of OME. Children with blood group B did not have lower risk. Children with blood group AB had lower relative risk for OME, but not significantly so. Examining Rhesus factor as a predictor for OME, no relationship was found. It is concluded that blood group O (and possibly AB) plays a preventive role, while blood group A or B are burdensome for OME.

Cytology of middle ear fluid during acute otitis media

BACKGROUND

Limited information is available on the cellular characteristics of the middle ear fluid (MEF) during acute otitis media (AOM).

OBJECTIVES

To determine the white blood cell (WBC) composition of the MEF in AOM before and during antibiotic therapy.

MATERIALS AND METHODS

Total WBC and differential counts were determined in the MEF of 96 infants and children (ages 2 weeks to 3 years) with AOM who were receiving antibiotics. WBC counts were reported as number of WBC/mg MEF (mean +/- sd).

RESULTS

One hundred forty-five MEF samples were obtained by tympanocentesis at enrollment (Day 1), and 36 samples were collected on Days 4 to 5 after initiation of antibiotic therapy. Sixty-one percent of the patients were <1 year of age, and 38% were receiving antibiotic therapy at enrollment. Twenty-eight MEF samples were paired (same ear, Day 1 and Days 4 to 5). One hundred twelve pathogens were isolated from 95 of 145 (66%) culture-positive samples obtained on Day 1: 67 Haemophilus influenzae, 40 Streptococcus pneumoniae and 5 others. MEF WBC counts were lower on Day 1 in patients who had received previous antibiotic therapy than in those who had not (432.4+/- 412.8 vs. 590.5 +/- 436.8, P = 0.03). WBC counts were higher on Day 1 in culture-positive than in culture-negative samples (603.9 +/- 504.9 vs.421.4 +/- 373.4, P = 0.02). WBC counts were higher on Day 1 in MEF samples positive for S. pneumoniae than in those positive for H. influenzae (799.2 +/- 641.5 vs.506.4 +/- 401.9, P = 0.04). There were no differences in the number of neutrophil WBC present in the samples obtained on Day 1 vs. Days 4 to 5 or between samples positive vs.samples negative for bacterial pathogens.

CONCLUSIONS

WBC counts were higher in the MEF of patients with culture-positive AOM than in those with culture-negative AOM and in those with AOM caused by S. pneumoniae.

[Cytological picture of fluid collected from middle ear in course of o.m.s. in children]

The fluid collected during operation from tympanic cavity of 37 children with o.m.s. was examined. Its cellular composition was assessed by microscopic observation in magnification of 400 in 10 different fields of view. Lymphocytes, neutrophiles, eosinophiles and macrophages were counted. The ratio of number of macrophages to the total number of lymphocytes granulocytes was expressed in percent. The concentration of proteins was evaluated using stripe method Multistix 10 SG and comparatively, after staining the fixed preparation with hematoxylin and eosine, on the basis of pink colour, which intensity is proportional to the amount of protein. The exudative fluid was found to be protein-rich; it contained numerous lymphocytes in 56% of samples; epithelioid cells were sparse or absent in 53% of samples; in 95% of samples eosinophiles were absent, or occurred in small numbers, in 65% of samples only few neutrophiles was found. The fraction of immature cells in total number of neutrophiles decreased evidently with increase of this number (r2 = 0.85); the average ratio of the number of macrophages to the total number of lymphocytes and granulocytes was 32%. The relationship between hypoacusia and cytological parameters of ear secretion was analysed. It was discovered, that there was no dependence between the value of hypoacusia and the concentration of proteins, neither the total number of cells in fluid. With the increase of hypoacusia, the number of eosinophiles decreased. Further studies are required to check whether hypoacusia is dependent on the amount of secretion.

Adenoids provide a microenvironment for the generation of CD4(+), CD45RO(+), L-selectin(-), CXCR4(+), CCR5(+) T lymphocytes, a lymphocyte phenotype found in the middle ear effusion

Adenoidectomy in children with otitis media with effusion reduces inflammation in the middle ear by an unknown mechanism. Potentially, the adenoids of these children may serve as a site for the differentiation of lymphocytes, which after entering blood circulation eventually extravasate in the middle ear mucosa and thereby contribute to excessive inflammation. During lymphocyte extravasation various adhesion molecules and chemokines play a crucial role. To evaluate possible connections between the adenoids and middle ear inflammation, the expression of the chemokine receptors CXCR4 and CCR5 and the lymphocyte homing receptor L-selectin were analyzed in adenoidal and middle ear lymphocytes. It was found that most CD4(+) T lymphocytes in the middle ear effusion express the memory phenotype marker CD45RO and the chemokine receptors CXCR4 and CCR5, but are negative for the lymphocyte homing receptor L-selectin. This cell phenotype was rare in peripheral blood but was found much more frequently in the adenoids. The results suggest that the adenoids provide a microenvironment for the generation for CD4(+), CD45RO(+), L-selectin(-), CXCR4(+) and CCR5(+) T lymphocytes. Further, these cells may include cells that have the capacity to home to the middle ear mucosa. As the adenoidal CD4(+) memory phenotype CD45RO(+) T cells expressed the activation antigen CD69 and included cells expressing the HIV co-receptors CXCR4 and CCR5 at a high level, they may be permissive for HIV infection.

Soluble L-selectin and interleukin-8 in otitis media with effusion

OBJECTIVE

adhesion of leukocytes to vascular endothelium and their invasion into local tissues are important steps in inflammation. L-selectin plays a crucial role in leukocyte rolling and adhesion on endothelial cell surface. Interleukin-8 (IL-8) is a potent chemotactic substance toward neutrophils and lymphocytes-T and mediate their migration to local inflammation. The levels of soluble L-selectin (sL-selectin) and IL-8 were measured in middle ear effusions (MEE) from children with otitis media (OM) to estimate their role in pathogenesis of inflammation in middle ear.

METHODS

MEE were collected from 113 ears of 62 children during routine myringotomy. The entire specimen was diluted with phosphate-buffered saline (PBS) to 2 ml and centrifugated at 1500 rpm for 15 min to separate cellular components. Supernatants of MEE were stored frozen at -20 degrees C for sL-selectin and at -80 degrees C for IL-8 assessment. The concentration of sL-selectin and IL-8 were estimated with ELISA and compared with total protein concentration measured by Bradford assay.

RESULTS

MEEs from children with chronic mucous otitis media contained significantly higher mean concentrations of IL-8 559.4 pg/mg total protein (TP) (+/-535.6) in comparison with normal serum 17.79 pg/mg TP (+/-10.9), serous OM 40.3 pg/mg TP (+/-28.1) and purulent OM 104.4 pg/mg TP (+/-128.6). High concentration of IL-8 was found in MEE from the children with early recurrence of OMS. The levels of sL-selectin were higher in purulent effusions 77.2 ng/mg TP (+/-67.4) than those of chronic mucoid 27.6 ng/mg TP (+/-36.7) and serous OM 26.3 ng/mg TP (+/-27.1).

CONCLUSION

the results support a hypothesis that IL-8 can be responsible for prolongation of inflammatory process in middle ear, therefore long-term treatment and observation of children with the high levels of IL-8 in MEE may be necessary. Elevated level of sL-selectin in acute OM suggests the involvement of L-selectin in the acute phase of OM.

Evidence of eosinophil, neutrophil, and mast-cell mediators in the effusion of OME patients with and without atopy

BACKGROUND

This study was designed to measure the involvement of eosinophils, neutrophils, and mast cells in the middle ear of patients with OME and to see whether that inflammatory response differed depending on whether or not the patient was atopic.

METHODS

Levels of ECP, MPO, and tryptase were measured in effusion from 97 patients whose atopic status was determined by in vitro testing with 12 inhalants and five foods.

RESULTS

Seventy-nine of 97 OME patients (81%) were atopic, among whom 86% (68/79) had elevated levels of effusion ECP, and 64% (23/36) had elevated tryptase. Mean ECP was 166 microg/l vs 3.38 microg/l, mean MPO was 6231 microg/l vs 116 microg/l, and mean tryptase was 4.8 microg/l vs 1.34 microg/l in atopic vs nonatopic ears. Total serum IgE did not differ between atopics and nonatopics (P=0.28).

CONCLUSIONS

The inflammatory response by eosinophils, neutrophils, and mast cells in the middle ear was distinctly different between atopic and nonatopic patients (P < 0.001). This study provides evidence that eosinophils and mast cells, both essential to a Th-2 driven immune response, are present in the majority of ears with chronic OME, and supports the hypothesis that middle-ear mucosa, like that of the rest of the upper respiratory tract, is capable of an allergic response.

Biological activities of antibodies elicited by lipooligosaccharide based-conjugate vaccines of nontypeable Haemophilus influenzae in an otitis media model

Vaccination of chinchillas with nontypeable Haemophilus influenzae (NTHi) lipooligosaccharide (LOS) conjugates protected against otitis media. Correlations between the levels of conjugate-induced LOS antibodies (Abs) in sera and middle ear fluids (MEFs) and Ab-mediated biological functions and protection were examined. Following parenteral vaccination and middle ear challenge, all vaccinated animals, but none of the controls, had high titers of anti-LOS in their sera and MEFs. There was a correlation between the levels of anti-LOS IgG + M, IgG or IgA in the sera and in the MEFs (P < 0.001). An inverse correlation was found between the level of serum IgG + M and bacterial counts and between the levels of MEF Abs and bacterial counts at the early postchallenge stage (P < 0.05). Of the 39 vaccinated animals, 44% showed complete protection against otitis media, 46% (18/39) of their sera inhibited adherence of NTHi to human epithelial cells, 49% (19/39) demonstrated bactericidal activity and 49% (19/39) showed opsonophagocytic activity. In contrast, none of the controls (19) were protected, none of their sera inhibited bacterial adherence or had bactericidal activity and only 21% showed opsonophagocytosis. Our interpretation is that vaccine-induced LOS Abs transuded into the middle ear and conferred immunity to NTHi by binding to LOS of NTHi, inhibition of NTHi adherence to epithelial cells and complement-mediated bacteriolysis (or opsonophagocytosis).

[A comparative study of intoxication severity in patients with acute purulent otitis media]

Plasma levels of medium molecular peptides (MMP) were measured and Paramecium test was made in 28 patients with acute otitis media purulenta (AOMP). Of these, 18 patients had complicating mastoiditis. The baseline results of both tests correlated with clinical symptoms of systemic endogenic intoxication. Paramecium test returned to normal after one day of treatment. Informative value of this test fell with detoxication contrary to plasma MMP value which correlated with the degree of intoxication and remained informative through detoxication being able to show even residual subclinical toxicity. The MMP test is a method of choice in assessing intoxication in patients with AOMP and its complications.

Measuring antibiotic levels in otitis media

Antibiotic concentrations in serum and middle ear effusion (MEE) are important in determining treatment success in acute otitis media, but studies to measure concentration levels are often performed in chronically infected patients where there is little inflammation. In this open, single-center study, 26 patients with acute otitis media were enrolled to assess antibiotic penetration in inflamed ears. Of the 26 patients, 4 were non-evaluable, 6 formed a control group and the others were randomized into three groups. Each of the three groups was given a single oral dose of cefuroxime axetil suspension, 15 mg/kg. Food was administered approximately 20 minutes before the drug in order to maximize drug absorption. Cefuroxime concentrations in serum and MEE were assessed at 2-3 (group 1), 3-4 (group 2) and 4-5 (group 3) hours following dosing. Sampling of MEE was performed with tympanocentesis under local anesthesia and the drug was assayed by HPLC-mass spectrometry. The serum concentrations of cefuroxime were found to be above the minimal inhibitory concentration (MIC) for penicillin-sensitive Streptococcus pneumoniae for 100% of the dosing interval and 42% of the time for intermediate-resistant strains. For both Haemophilus influenzae and Moraxella catarrhalis, serum cefuroxime levels were above the MIC for 42% of the time between doses. This study indicates that cefuroxime axetil penetrates the inflamed middle ear effectively in acute otitis media after oral dosing. Serum levels were maintained above the MICs of important bacterial pathogens in otitis media for more than 5 hours after dosing, which is equivalent to 42% of the dosing interval. Thus, the important statistic of 40-50% of time above MIC, required for beta-lactam antibiotics to produce the maximal bacteriological cure rate of 80-85%, is achieved.

Levels of Eosinophil Cationic Protein and Myeloperoxidase from Chronic Middle Ear Effusion in Patients with Allergy and/or Acute Infection

BACKGROUND AND OBJECTIVE: Allergy may play a role in the middle ear inflammation that leads to otitis media with effusion. The purpose of this study was to determine whether an elevated mediator correlated with the patient's disease and thus could be used to differentiate allergy vs. infection as the cause of the middle ear inflammation.

METHODS: We evaluated 57 individuals with otitis media with effusion, 32 with persistent effusion but no recent acute infection, 14 with recent infection and purulent otitis media with effusion, and 11 healthy subjects. The mediator activity of eosinophils and neutrophils in effusion was studied in patients characterized as having allergy by positive intradermal skin test results and positive radioallergosorbent test results. Eosinophils were characterized by measurement of eosinophil cationic protein in the effusion. Neutrophils were characterized by measurement of myeloperoxidase in the effusion. The levels of eosinophil cationic protein and myeloperoxidase in patients with and without allergy were correlated to patient history.

RESULTS: Significantly elevated levels of both eosinophil cationic protein and myeloperoxidase indicated that inflammation in the ear of patients with otitis media with effusion was characterized by a pronounced involvement of both eosinophils and neutrophils. Eighty-nine percent of all patients with disease had allergy. A higher ratio of myeloperoxidase to eosinophil cationic protein in patients with purulent otitis media with effusion indicated that in patients with a superimposed acute infection, neutrophil activity was increased even further. The level of eosinophil cationic protein was elevated only during the effusion of patients with allergies as compared with controls ( p < 0.01). Among 29 cases of nonpurulent otitis media with effusion, 96.5% had allergic immune-mediated disease proved by skin testing, which was related clinically to their ear disease. Eighty-nine percent (89.6%) of these patients had eosinophil cationic protein levels greater than 10 μg/L.

CONCLUSION: Middle ear eosinophil cationic protein may be used as a marker of related allergy.

Platelet-activating factor and leukotrienes in acute otitis media, secretory otitis media, and chronic otitis media on the acute excerbation

The present study was carried out for the purpose of measuring platelet activating factor (PAF) and leukotrienes (LTs) in middle ear fluid (MEF) or in otorrhea of children with acute otitis media (AOM), with secretory otitis media (SOM), and with chronic otitis media (COM) on the acute exacerbation. PAF, LTC4, and LTD4+LTE4 concentrations were measured by radioimmunoassay in purulent MEFs obtained from 15 ears of 15 children with AOM, in mucoid or gluey MEFs from 16 ears of 15 children with SOM, and in purulent otorrhea from 9 ears of 9 children with COM on the acute exacerbation. PAF concentrations were 25.4 +/- 9.0 ng/mg total phospholipid (TPL) in AOM, 4.9 +/- 1.9 ng/mg TPL in SOM, 20.7 +/- 15.7 ng/mg TPL in COM, demonstrating significant differences between AOM and SOM (p < 0.05) and between COM and SOM (p < 0.01). LTC4 concentrations were 92.9 +/- 73.8 pg/mg total protein (TP) in AOM, 52.0 +/- 42.5 pg/mg TP in SOM, and 28.5 +/- 11.2 pg/mg TP in COM. LTD4+LTE4 concentrations were 326.5 +/- 177.0 pg/mg TP in AOM, 288.2 +/- 144.6 pg/mg TP in SOM, and 94.0 +/- 58.1 pg/mg TP in COM, demonstrating significant differences between AOM and COM and between SOM and COM (p < 0.01). The results obtained indicated that PAF was involved in the onset of AOM and COM on the acute exacerbation, and that LTs played an important role in SOM.

Maternal blood group in otitis media with effusion

Risk factors for otitis media with effusion (OME) have proved difficult to apply in selecting persistent cases, or those otherwise requiring intervention. Explanations may include low predictive values of individual factors and the costs of data collection. In this study, profiles on 225 children from conception to age 7 years were compiled from medical and Health Authority records and structured interviews with parents. On the grounds that nearly all cases receiving medical intervention after waiting and onward referral are more than transitory (although many persistent cases will not receive such attention) this was taken as the dependent variable--a marker of persistence. Established risk factors and maternal blood group A were considered singly to predict intervention, then in combination using logistic regression. Maternal blood group A gave a relative risk (RR) for intervention of 2.82. The noted occurrence of an attack of acute otitis media (AOM) before the first birthday gave a RR of 6.13. When these two factors were used together, the RR climbed steeply to 26.77. These findings suggest that further research is justified into the nature of the influence of blood group A on OME, and the use of combinations of risk factors to give enhanced prediction.

Altered immunoregulation in otitis media with effusion in children: presence of serum immuno-inhibitory factors

In the present study serum immuno-inhibitory factors in children with otitis media with effusion (OME) were evaluated. The study included 23 children with OME and 23 healthy age-and-sex-matched controls. Serum inhibitory activity (SIA) was expressed as the inhibition index of proliferative response to T-cells lectins. In almost all the children with OME the indices reflecting T-cell proliferation were below the range of those in the control group. The results suggest that the activity of the factor(s) which affect T-cell proliferation may be included in mechanisms contributing to the persistence of OME in children. Further studies are needed in order to establish the cellular and molecular aspects of serum inhibitory activity, as well as its significance in the pathogenesis of OME.

Middle ear fluid lysozyme source in experimental pneumococcal otitis media

Middle ear infection with Streptococcus pneumoniae is important in the pathogenesis of acute and chronic otitis media, and lysozyme in middle ear fluid (MEF) is an important inflammatory mediator in this disease. To determine the source of lysozyme during the early period of acute pneumococcal otitis media, chinchillas were irradiated to induce neutropenia, and their middle ears were inoculated with heat-killed, encapsulated pneumococci. The number of inflammatory cells and concentration of lysozyme were measured in MEF between 6 and 72 hours after inoculation. In pneumococcus-inoculated ears, the mean number of inflammatory cells but not lysozyme was significantly lower in MEF from irradiated animals than that from nonirradiated animals at 6 hours. Since lysozyme accumulated in MEF before the influx of inflammatory cells in irradiated animals, the initial release of this inflammatory mediator is most likely not from inflammatory cells; and mucosal epithelial cells, the only other known source of lysozyme in the middle ear environment, were the probable source induced by the direct stimulation of pneumococci. Inflammatory cells may contribute lysozyme later in the inflammatory response, since cellular and lysozyme concentrations in irradiated and nonirradiated animals were similar between 24 and 72 hours. These results suggest that future therapeutic interventions to limit middle ear inflammation in acute otitis media may need to recognize the direct action of pneumococcal cells or their envelope components on middle ear epithelium.

The relationship between proteases activity and glycoprotein levels in middle ear effusions from experimental otitis media in cats

The relationship between lysosomal proteases activity (elastase and cathepsin B) and levels of mucous glycoproteins in middle ear effusions (MEEs) was studied using a cat model of otitis media with effusion (OME) induced by Eustachian tube obstruction (ETO). The ratio of cathepsin B activity to total protein concentration (TPC) in MEE was 25.6 +/- 19.4 RFU/g x dl-1 at 1 week after ETO, and increased with the duration of OME. The ratio of elastase activity to TPC had a significant correlation to total leukocyte count. The ratio of fucose levels to TPC, which is one of the parameters reflecting levels of mucous glycoprotein, at 1 week after ETO was significantly higher than that at both 2 and 4 weeks after ETO. The percentage of glycoprotein levels absorbed to wheat germ lectin was highest at 1 week after ETO, and decreased with the duration of OME. In conclusion, mucous glycoproteins in cat occupy a larger portion of glycoproteins in MEE at the early stage of OME, and elastase and other lysosomal proteases may play a role in both stimulation of mucin release from goblet cells and mucin degradation. The balance of these processes seems to be a key factor determining mucin levels in MEEs.

Cellular events in relation to bacteria-specific antibodies in middle ear effusion during acute otitis media

The proportions of neutrophils and lymphocytes, the total number of viable lymphocytes and their spontaneous proliferating activity as well as the proportion of B-cells were determined in 238 middle ear effusion (MEE) samples from 124 ears and in 40 serum samples of 85 children in relation to the presence of bacteria-specific antibodies in MEE and the clinical outcome of acute otitis media (AOM) during the course of AOM. The percentage of lymphocytes was higher, and that of the neutrophils lower, in the ears with bacteria-specific antibodies than in the ears with no antibodies. The higher proportion of MEE lymphocytes and the presence of antibodies correlated to the faster resolution of AOM. Moreover, the total number of viable lymphocytes and the proliferating activity of these cells were related to the presence of specific antibodies in MEE. The findings of this study underline the importance of local mucosal immunity taking place in the middle ear in connection with bacteria-specific antibodies in resting AOM.

Beta 2-microglobulin in otitis media with effusion

beta 2-Microglobulin (beta 2M) is a low-molecular-weight protein present in serum and other fluids during various autoimmune or chronic inflammatory diseases. beta 2-Microglobulin was measured in middle ear effusion (MEE) and serum samples obtained from 36 patients with chronic otitis media with effusion. Using a quantitative competitive enzyme immunoassay, we were able to demonstrate beta 2M in 98% of the MEE samples. The mean concentration of beta 2M was higher in the MEE samples than in the serum samples. There was considerable variability between ears in those patients with bilateral MEE. There was no correlation between beta 2M concentration and the patients' age, sex, MEE type, and culture results, or cytologic profiles of the MEEs. This increased beta 2M may reflect earlier lymphocyte activity during the inflammatory process.

Inflammatory mediators in chronic otitis media with effusion

Otitis media with effusion (OME) is a common middle ear inflammatory disease in the pediatric population. This article determines concentrations of three functionally and metabolically distinct inflammatory mediators in middle ear effusions (MEE) and corresponding plasma of children with OME. One hundred two patients (mean age, 4.9 years) with persistent OME were studied. Middle ear effusions were collected from all subjects and plasma from a subset at the time of tympanostomy tube insertion. Histamine was assayed radioisotopically, 13,14-dihydro-15-keto-prostaglandin F2 alpha (stable PGF2 alpha metabolite) by radioimmunoassay, and neutrophil chemotactic factor of anaphylaxis by modified Boyden chamber. Mean MEE levels of the mediators (39 +/- 13 ng/mL, 462 +/- 179 pg/mL, and 264% +/- 57% positive control, respectively) were markedly higher than those of corresponding plasma (0.5 +/- 0.1 ng/mL, 285 +/- 127 pg/mL, and 47% +/- 5% positive control, respectively). The mean histamine content of mucoid effusions (43.2 +/- 56.9 ng/mL) was significantly higher than that of purulent (22.5 +/- 10.5 ng/mL) and serous (17.9 +/- 16.8 ng/mL) effusions. Higher histamine levels were observed in effusions positive for Haemophilus influenzae when compared with those with other pathogenic isolates. The high concentrations of these mediators in MEE and their potential for inducing or sustaining the inflammatory process supports a role in the pathogenesis of OME.

Biochemical and cytological studies of immune-complex-induced otitis media in the chinchilla

The pathogenesis of immune complex (IC)-induced otitis media in the chinchilla was studied through cytological and biochemical analyses of middle ear fluid (MEF) recovered after instillation of premade IC. The number to total leukocytes was 3.03 +/- 2.13 X 10(6)/cm3, and mainly involved neutrophils (72.3%) and macrophages (22.7%). The mean value of total protein, alpha 1-antitrypsin (alpha 1-AT) and alpha 2-macroglobulin (alpha 2-M) was 27.1 mg/ml, 189.5 and 75.2 mg/dl. The number of leukocytes had a significant correlation with the levels of total protein, alpha 1-AT and alpha 2-M (P less than 0.01). The inflammatory reaction induced by premade IC is characterized by an increased vascular leakage and an infiltration of leukocytes into the locus. The percentage of macrophages in the total leukocytes was larger in IC-induced otitis media than that in antigen-induced otitis media. These findings suggest that cellular events in the early stage of IC-induced otitis media may be different from antigen-induced otitis media.

Amoxicillin twice daily in the treatment of acute otitis media in infants and children

A total of 110 children with acute otitis media were assigned randomly to treatment with 60 mg/kg per day amoxicillin in a twice-daily (group A) or a thrice-daily (group B) regimen for 10 days. Patients were scheduled for follow-up examinations at mid-treatment, 5 days after the end of therapy and 30, 60, 90 days after starting therapy. At 15 days 6 out of 55 patients (10.9%) treated with amoxicillin twice daily were considered treatment failures compared to 4 children (7.2%) in the thrice daily group. Rates of cure, recurrent otitis media and persistent middle ear effusion were comparable in the two groups of patients at later time intervals. By 90 days the total cure rate was 42.3% (22/52) in children treated twice daily and 41.5% (22/53) in those who had received amoxicillin thrice daily. At the same time persistence of bilateral and unilateral effusion was noted in 12/52 (23.1%) and 8/52 (15.3%) children in group A and in 16/53 (30.1%) and in 10/53 (18.9%) in group B respectively. No significant difference was noted in the two treatment regimens with regard to adverse side effects. Because reduction in division of the amoxicillin dose caused no significant difference in the efficacy of antibiotic treatment of acute otitis media in infants and children, we think that this simplified scheme of therapy can routinely be used in clinical practice and thus improve compliance to antibiotic administration.

Hyaluronic acid in secretory otitis media. A biochemical study of mucoid middle-ear effusions and serum

Middle-ear effusions of the mucoid type were collected from 14 children with secretory otitis media and analysed by a sensitive assay for hyaluronic acid. The concentration of the polysaccharide varied between three and 42 micrograms/g. in different patients but was in the same range in effusion material taken from the two ears of the same patient. As the hyaluronic acid concentrations were high compared to the serum levels, the results indicate that the effusion material contains a component derived from connective tissue.

Immunoglobulin E in mucoid secretory otitis media

19 serum and 23 middle ear mucoid fluid samples from patients with chronic secretory otitis media (SOM) were analyzed for total IgE using the PRIST technique and for specific IgE against dog epithelium, house dust mite, milk, egg-white and wheat using the RAST technique. All serum samples showed IgE values well within the normal range, and the middle ear fluid-serum ratio for total IgE was less than 1. In three sera there was a weak (score 1) positive RAST result to milk (2 cases) and to egg-white (1 case). None of the middle ear fluids showed positive reactions. Routine clinical assessment of total and specific IgE is not indicated in SOM.

Histamine levels in middle ear effusions

The presence of histamine in 131 middle ear effusions was determined by the fluorometric assay technique. This potent mediator of inflammation was found in significant amounts in most of the samples, suggesting that it may play an important role in the pathogenesis of otitis media with effusion. It is postulated that mast cells located in the lamina propria of the tympanic mucoperiosteum are triggered to degranulate and release histamine by anaphylatoxin derived from activation of the complement system.

Distribution of ABO blood groups in secretory otitis media and cholesteatoma

The ABO blood groups of 610 patients with documented secretory otitis media (SOM) and of 361 patients with cholesteatoma were compared with those of a control group. In cholesteatoma a normal distribution appeared while in SOM a preponderance of group A or shortage of group O was statistically significant and the incidence ratio was 1.49. In both disease entities a preponderance of males was found. The blood group abnormalities of SOM may indicate hereditary trends and they oppose the theories of SOM being the 'missing link' in the development of cholesteatoma.

Granulocyte protease inhibition in acute and chronic middle ear effusion

A comparative study was made of granulocyte proteases and protease inhibitors in middle ear effusions (MEE) from patients with acute otitis media (OMA) and serous otitis media (SOM). The mean concentrations of the granulocyte proteases, neutral protease and elastase were three- to fourfold higher in OMA as compared to SOM effusions. The mean concentration of granulocyte elastase in SOM effusions was approximately 1 400, and in OMA effusions 5 500 times higher than the corresponding plasma concentrations. In OMA patients the individual MEE/plasma ratios of the main plasma protease inhibitors, alpha 1-antitrypsin, antichymotrypsin and alpha 2-macroglobulin, showed a positive uniform correlation with corresponding albumin MEE/plasma ratios. In SOM effusions, the concentration of alpha 2-macroglobulin was low, indicating a restricted membrane passage in SOM. In SOM effusions both alpha 1-antitrypsin and the locally produced antileukoprotease showed a residual inhibitory capacity. In OMA effusions the inhibitory capacity of anti-leukoprotease was saturated, whereas there was a residual inhibitory capacity of alpha 1-antitrypsin. However, in those OMA effusions, where large amounts of alpha 1-antitrypsin complexes with granulocyte proteases were found, most of the remaining free alpha 1-antitrypsin was inactive.