Nasal mucosal changes in children treated with gammaglobulin. Aspects on middle ear pathology and nasopharyngeal bacteriology

The present study was undertaken to evaluate possible beneficial effects of gammaglobulin treatment every 3 weeks during 6 months of 6-month to 2-year-old children. Every second of 44 children with recurrent acute otitis media (RAOM) received gammaglobulin, the other 22 served as controls. Nasal mucosal biopsy specimens were taken at 6-month intervals and analysed by light microscopy (LM) and scanning electron microscopy (SEM). Additional biopsies were obtained from another 15 children with RAOM and from 27 "healthy" children. No morphological differences in nasal mucosa could be demonstrated between the gammaglobulin treated and non-treated children. The structural changes observed in the first biopsy specimens usually persisted for at least 6 months, i.e. the study period, and were most prominent in the epithelium. Children with two or more episodes of acute otitis media (AOM) during the study period had more microabscesses compared to the children without any episode of AOM. Microabscesses were also more common in cases with secretory otitis media compared to cases with normal middle ear status. No morphological differences could be revealed related to the age of the children. Microabscesses, cell destruction and discontinuity of the epithelial lining were more common in children who harboured Branhamella catarrhalis in their nasopharynx. We conclude that intramuscular administration to children of gammaglobulin every 3 weeks during half a year neither improved their resistance to RAOM nor reduced the frequency or extent of structural changes in their nasal mucosa.