Clinical characteristics of respiratory syncytial virus infection-associated acute otitis media

Background:  It is known that children with respiratory syncytial virus (RSV) infection frequently have complications of acute otitis media (AOM).
Methods:  The hospital records of 148 inpatients aged 6–35 months who had RSV infection between January 2004 and December 2007, were retrospectively investigated.
Results:  Forty-six out of 148 children (31%) had AOM. There was a significantly greater number of children with fever who had AOM ( P  = 0.005). The percentage of children with β-lactamase-non-producing ampicillin-resistant (BLNAR) Haemophilus influenzae in nasopharyngeal culture who had AOM showed a tendency to be greater than that of those who did not have AOM, but this was not statistically significant ( P  = 0.068). Moreover, BLNAR H. influenzae was positive in middle ear fluid specimens from four of five children with AOM who underwent tympanocentesis. There were no significant differences in the incidence of lower airway infection, leukocytes counts, or serum C-reactive protein levels between children with and without AOM.
Conclusions:  Children who had RSV infection with AOM had a higher incidence of fever than those without AOM.     

The role of respiratory syncytial virus and other viral pathogens in acute otitis media

We utilized recently developed enzyme immunoassay techniques to examine the role of selected viruses in the etiology of acute otitis media. Viral pathogens were found in middle ear fluids obtained from 13 (24%) of 53 children with acute otitis media; respiratory syncytial virus accounted for ten of the 13 viral agents identified. In addition, respiratory syncytial viral antigen was found in nasopharyngeal washings obtained from 15 of the 53 children. Seven of these children had RSV identified as the sole middle ear pathogen, whereas six children had otitis caused by Streptococcus pneumoniae as either the sole middle ear pathogen or in combination with RSV. Similarly, all three children with respiratory infections caused by influenza virus had ear infections caused by bacterial pathogens, either alone or in combination with influenza virus. These findings suggest that, in patients with viral respiratory infection, coexisting acute otitis media may be associated with the recovery of either viruses or bacteria from the middle ear exudates.     

Increased prevalence of otitis media following respiratory syncytial virus infection

Aim: The aim of this study was to analyse whether, during the 18 months following a respiratory syncytial virus (RSV) infection in infants, there were differences in the prevalence of common infections such as acute otitis media (AOM), compared with controls. We also wanted to see whether passive smoking could be a contributory factor. Methods: In a longitudinal study, 33 children who attended the emergency room with an RSV infection (age ≤7 months) were compared with 37 age‐matched controls recruited from routine infant check‐ups. The 18‐month follow‐up consisted of a questionnaire focusing on environmental factors and the child’s health during the last 12 months. An allergy skin prick test (SPT) was performed and venous blood was obtained. Results: The prevalence of AOM and the use of antibiotics were higher in the RSV group than in the controls (p = 0.009 and p = 0.027 respectively). The number of AOMs and the use of antibiotics correlated, r = 0.8. In the RSV group, one or both parents smoked in 52% compared with 14% in the controls (p < 0.001). There were no differences in allergy SPT results. Conclusion: The infants with RSV infection had AOM and were prescribed antibiotics more frequently during the follow‐up period. Furthermore, smoking was far more common among the parents of the RSV group. We speculate that passive smoking could be a contributory factor to the infections noted here.     

对3370例上呼吸道感染小儿并发急性中耳炎情况的调查

在美国等西方国家,20世纪90年代的统计数字表明,近2／3的婴幼儿至少患过1次急性中耳炎,50％的儿童患过两次或更多。为了了解我院儿科上呼吸道感染并发急性中耳炎的情况,于2002年1～12月对来我院门诊就诊时登记在册的上呼吸道感染的患儿3370例,均行耳窥镜检查,发现疑似急性中耳炎,再由耳鼻喉科会诊,现将结果报告如下。     

Effect of viral respiratory tract infection on outcome of acute otitis media

We prospectively studied 271 infants and children (2 months to 7 years of age) with acute otitis media (AOM) for viral and bacterial causes, outcome at the end of therapy, and frequency of recurrence within 1 month. Comprehensive virologic methods, including viral antigen detection, cell culture, and serologic studies, were used to diagnose viral infection of the respiratory tract, middle ear, or both. Evidence of viral infection was found in 46% (124/271) of patients with AOM. Sixty-six patients (24%) had virus or viral antigen in the middle ear fluid; 50 of these patients (76%) also had bacteria in middle ear fluid, and 16 (24%) had virus alone. More patients with AOM and combined bacterial and viral infection (51%) had persistent otitis (3 to 12 days after institution of antibiotic treatment), compared with those with only bacterial otitis (35%; p = 0.05) or patients with only viral infection (19%; p less than 0.01). Of patients with only viral infection, 4 of 10 with virus in middle ear fluid had persistent otitis, compared with none of 11 patients who had virus only in nasal wash specimens or whose viral infection was diagnosed only by serologic studies. Our data suggest that viruses interact with bacteria and that concurrent viral infection can significantly worsen the clinical course of bacterial AOM. The presence of virus in middle ear fluid may contribute to the pathogenesis and outcome of bacterial AOM. The mechanism of these interactions deserve further investigation.     

Acute otitis media and respiratory virus infections

We studied the association of acute otitis media with different respiratory virus infections in a pediatric department on the basis of epidemics between 1980 and 1985. Altogether 4524 cases of acute otitis media were diagnosed. The diagnosis was confirmed by tympanocentesis in 3332 ears. Respiratory virus infection was diagnosed during the same period in 989 patients by detecting viral antigen in nasopharyngeal mucus. There was a significant correlation between acute otitis media and respiratory virus epidemics, especially respiratory syncytial virus epidemics. There was no significant correlation between outbreaks of other respiratory viruses and acute otitis media. Acute otitis media was diagnosed in 57% of respiratory syncytial virus, 35% of influenza A virus, 33% of parainfluenza type 3 virus, 30% of adenovirus, 28% of parainfluenza type 1 virus, 18% of influenza B virus and 10% of parainfluenza type 2 virus infections. These observations show a clear association of respiratory virus infections with acute otitis media. In this study on hospitalized children Haemophilus influenzae strains were the most common bacteriologic pathogens in middle ear fluid, occurring in 19% of cases. Streptococcus pneumoniae was present in 16% and Branhamella catarrhalis in 7% of cases. There was no association between specific viruses and bacteria observed in this study.     

Respiratory virus infection as a cause of prolonged symptoms in acute otitis media

We studied respiratory viruses in 22 children with acute otitis media who had failed to improve after at least 48 hours of antimicrobial therapy. The mean duration of preenrollment antimicrobial therapy was 4.8 days. For comparison we studied 66 children with newly diagnosed acute otitis media. Respiratory viruses were isolated from middle ear fluid or from the nasopharynx, or both, significantly more often in the patients unresponsive to initial antimicrobial therapy than in the comparison patients (68% vs 41%, p less than 0.05). Viruses were recovered from the middle ear fluid in 32% of the study patients and from 15% of the comparison group. Bacteria were isolated from the middle ear fluid of four (18%) children in the study group; one child had an isolate resistant to initial antimicrobial therapy. All four children with bacteria in the middle ear fluid had evidence of concomitant respiratory virus infection. Our results indicate that respiratory virus infection is often present in patients with acute otitis media unresponsive to initial antimicrobial therapy, and may explain the prolongation of symptoms of infection. Resistant bacteria seem to be a less common cause of failure of the initial treatment.     

Viral load and acute otitis media development after human metapneumovirus upper respiratory tract infection

The role of human metapneumovirus (hMPV) in acute otitis media complicating upper respiratory tract infection (URI) was studied. Nasopharyngeal specimens from 700 URI episodes in 200 children were evaluated; 47 (7%) were positive for hMPV, 25 (3.6%) with hMPV as the only virus. Overall, 24% of URI episodes with hMPV only were complicated by acute otitis media, which was the lowest rate compared with other respiratory viruses. hMPV viral load was significantly higher in children with fever, but there was no difference in viral load in children with hMPV-positive URI with or without acute otitis media complication.     

Incidence of acute otitis media associated with group A and B respiratory syncytial virus infections

The comparative association of respiratory syncytial virus group A and B infections with acute otitis media was determined by analysing the hospital records of children with community–acquired respiratory syncytial virus infection during three successive outbreaks from 1987 to 1992. Of 326 episodes analysed, 192 (59%) were caused by group A and 134 (41%) by group B infections. Acute otitis media was diagnosed in 101 (75%) children with group B infection, compared with 119 (62%) with group A infection (p = 0.01). Group A infections were more often associated with wheezing (71% versus 59% in group B; p = 0.02) and oxygen therapy in inpatients (48% versus 31%, respectively; p = 0.008). The higher incidence of acute otitis media associated with group B infections was observed both after adjustment for potential confounding variables and during each outbreak.     

Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age

Infants and young children are prone to developing upper respiratory tract infections, which often result in bacterial complications such as acute otitis media and sinusitis. We evaluated 623 upper respiratory tract infection episodes in 112 children (6-35 months of age) to determine the proportion of upper respiratory tract infection episodes that result in acute otitis media or sinusitis. Of all upper respiratory tract infections, 30% were complicated by acute otitis media and 8% were complicated by sinusitis. The rate of acute otitis media after upper respiratory tract infection declined with increasing age, whereas the rate of sinusitis after upper respiratory tract infection peaked in the second year of life. Risk for acute otitis media may be reduced substantially by avoiding frequent exposure to respiratory viruses (eg, avoidance of day care attendance) in the first year of life.     

Bacterial respiratory infections and otitis media

Bacterial infections of the respiratory tract are an important potential problem for children who attend group day care. Immunization (for Hib) or chemoprophylaxis, when appropriate, should lessen the risk and help to control or prevent the problem in many instances.