title: Cytokines, immunoglobulins, and bacterial pathogens in middle ear effusions.
abstract: OBJECTIVE
  To elucidate the role of cytokines, immunoglobulins, and bacterial pathogens in the middle ear effusions (MEEs) of children with otitis media (OM).
  
  
  METHODS
  Paired MEEs and serum samples collected from consecutive patients were assayed for immunoglobulins. Middle ear effusions were cultured for bacterial pathogens and assayed for interleukin-1 beta, interleukin-6, tumor necrosis factor alpha, and interferon gamma. The medical charts of the patients were retrospectively reviewed to define the history of OM.
  
  
  METHODS
  Seventy-five patients with a history of recurrent acute OM, persistent OM with effusion, or both. Exclusion criteria included the presence of a major coexisting condition, or an unclear or atypical history of OM.
  
  
  METHODS
  A private practice at a tertiary care children's hospital.
  
  
  METHODS
  At the time of tympanostomy tube placement, with the patient under general anesthesia, one MEE and a serum sample were collected.
  
  
  RESULTS
  Interleukin-1 beta was detected in 58% (44/75) MEEs; interleukin-6, 83% (60/72); tumor necrosis factor alpha, 37% (28/75) [corrected]; and interferon gamma, 61% (45/74). Concentrations of interleukin-1 beta, interleukin-6 and tumor necrosis factor alpha in MEEs were highly correlated with each other (P < .01 for each association) suggesting increased local production and the expected effects of cytokines stimulating their own production during OM. High concentrations of tumor necrosis factor alpha in MEEs were also associated with a history of multiple placements of tympanostomy tubes (r = .63).
  
  
  CONCLUSIONS
  These data suggest a regulatory role for cytokines in inflammation during OM, and suggest that high concentrations of tumor necrosis factor alpha in MEEs may be a marker for OM chronicity.
authors.affiliation: Department of Otolaryngology, Children's Hospital of Pittsburgh, Pa, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Yellon
authors.forename: W J
authors.initials: WJ
authors.lastname: Doyle
authors.forename: T L
authors.initials: TL
authors.lastname: Whiteside
authors.forename: W F
authors.initials: WF
authors.lastname: Diven
authors.forename: A R
authors.initials: AR
authors.lastname: March
authors.forename: P
authors.initials: P
authors.lastname: Fireman
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D016207:Cytokines / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis*; D007223:Infant; D007371:Interferon-gamma / Q000032:analysis; D007375:Interleukin-1 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000276:immunology* / Q000382:microbiology* / Q000601:surgery; D012008:Recurrence; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D016207:Cytokines; D007136:Immunoglobulins; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma