Viral respiratory infection in schoolchildren: effects on middle ear pressure.
OBJECTIVE
To evaluate the effect of uncomplicated viral respiratory infections (colds) on middle ear pressure in healthy school-aged children.


METHODS
Children (ages 2-12) with normal tympanograms before onset of illness had bilateral tympanometry daily except weekends for 2 weeks after the onset of a cold. Nasopharyngeal secretion obtained at onset of illness was cultured for bacterial pathogens of otitis media using selective agars and tested for rhinovirus, coronavirus, respiratory syncytial virus, influenza A and B, and parainfluenza 1-3 by reverse transcriptase polymerase chain reaction technology. Tympanometry was designated as abnormal with peak pressure of < or =-100 daPa or > or =50 daPa and/or a compliance peak of < 0.2 cm(3).


RESULTS
Eighty-six colds were studied, 82 in schoolchildren (5-12 years old) and 4 in 2- to 3-year-olds. Abnormal negative middle ear pressure occurred at least once during the 2 weeks after onset in 57 (66%) of the 86 colds. Tympanometry was abnormal in the first week after onset in 50 (88%) of the 57 colds and was abnormal on a single day in 17 (30%) of the 57. The middle ear pressure abnormalities were intermittent and shifted from one ear to the other ear from day to day. Reverse transcriptase polymerase chain reaction was positive for a respiratory virus in 56 (65%) of the 86 illnesses. Rhinovirus was found in 48% and respiratory syncytial virus in 14%. Pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) were detected in nasopharyngeal secretion in 29 (34%) of the 86 colds; the bacteria were in high titer (> or =10(3) cfu/mL) in 26 of the 29 positive specimens. None developed illness that required a visit to a physician. Age, detection of a respiratory virus, and presence of bacterial pathogen in the nasopharyngeal secretion had a negligible effect on the occurrence of abnormal tympanometry. Occurrence of negative middle ear pressure in winter-spring colds was significantly greater than in fall colds for unexplained reasons.


CONCLUSIONS
Transient negative middle ear pressure occurred in two thirds of uncomplicated colds in healthy children. This negative pressure, which may facilitate secondary viral or bacterial otitis media, seems to result from viral infection of the nasopharynx and distal tube causing bilateral eustachian tube dysfunction. Tympanometry provides an objective measure of the potential beneficial effects of investigational treatments on the risk of eustachian tube dysfunction/otitis media.
Winther
Birgit
B
University of Virginia Health System, Charlottesville, Virginia 22906, USA. bw8b@virginia.edu
Hayden
Frederick G
FG
Arruda
Eurico
E
Dutkowski
Regina
R
Ward
Penelope
P
Hendley
J Owen
JO
D000158:Acoustic Impedance Tests / Q000706:statistics & numerical data; D000256:Adenoviridae / Q000302:isolation & purification; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology*; D004432:Ear, Middle / Q000503:physiopathology*; D005064:Eustachian Tube / Q000503:physiopathology; D006801:Humans; D009305:Nasopharynx / Q000382:microbiology / Q000821:virology; D010033:Otitis Media / Q000175:diagnosis / Q000503:physiopathology; D011312:Pressure; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012621:Seasons; D013334:Students / Q000706:statistics & numerical data