Influenza A virus--induced acute otitis media.
To better understand the significance of viral upper respiratory tract infections in the pathogenesis of acute otitis media (OM), 27 adults underwent intranasal inoculation with influenza A virus. Monitoring consisted of antibody titer determination, tympanometry, and otoscopy. Microbiologic analysis consisted of cultures and polymerase chain reaction (PCR)-based detection for influenza A virus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. All subjects became infected with the challenge virus. By day 4, 16 (59%) developed middle ear pressures of -100 mm H2O or below and 4 (25%) of them developed OM. One subject (4%) developed purulent OM requiring myringotomy for pain relief. Middle ear effusion cultures were negative. PCR analysis of that subject's middle ear effusion and nasal washes were positive for influenza A virus and S. pneumoniae. These findings support a causal role for viral upper respiratory tract infections in the pathogenesis of OM, possibly mediated by middle ear underpressures and viral and bacterial middle ear infection.
Buchman
C A
CA
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Doyle
W J
WJ
Skoner
D P
DP
Post
J C
JC
Alper
C M
CM
Seroky
J T
JT
Anderson
K
K
Preston
R A
RA
Hayden
F G
FG
Fireman
P
P
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D005122:Exudates and Transudates / Q000821:virology; D005260:Female; D006801:Humans; D009980:Influenza A virus / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000821:virology; D010033:Otitis Media / Q000503:physiopathology / Q000821:virology*; D016133:Polymerase Chain Reaction; D011312:Pressure; D012680:Sensitivity and Specificity
D004279:DNA, Viral