title: Immune status and eustachian tube function in recurrence of otitis media with effusion.
abstract: OBJECTIVE
  To study the combined role of immune status and eustachian tube function in the development of recurrent bilateral otitis media with effusion (OME).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Three academic and general hospitals.
  
  
  METHODS
  Children aged 2 to 7 years with a first clinical episode of bilateral OME that persisted for at least 3 months; 136 (81%) of 168 eligible children participated. All children received bilateral tympanostomy tubes at study entry.
  
  
  METHODS
  Recurrence of bilateral OME within 6 months after tube extrusion.
  
  
  RESULTS
  Univariate analyses of various immunologic factors (IgA, IgG1, IgG2, IgG3, IgG4, mannose-binding lectin, and the FcgammaRIIa-H/R131 genotype) and eustachian tube function (forced response test) did not show any significant associations with bilateral OME recurrence. Multivariate analyses showed that children with closing pressures higher than the 75th percentile and IgA or IgG2 levels below the 50th percentile of the cohort were more likely to develop recurrent OME than children with closing pressures higher than the 75th percentile and IgA or IgG2 levels above the 50th percentile. The corresponding risk ratios were 6.3 (95% confidence interval [CI], 1.0-40.1) for IgA level and 3.0 (95% CI, 1.1-8.2) for IgG2 level. The multivariate analyses also revealed that increasing serum levels of functional mannose-binding lectin were associated with decreasing probabilities of developing recurrent OME (odds ratio, 0.7; 95% CI, 0.6-1.0).
  
  
  CONCLUSIONS
  Recurrence of bilateral OME after tympanostomy tube placement is more likely in children with a combination of low IgA or low IgG2 levels with poor eustachian tube function and decreased levels of mannose-binding lectin.
authors.affiliation: Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, the Netherlands.
authors.forename: Masja
authors.initials: M
authors.lastname: Straetemans
authors.forename: Niels
authors.initials: N
authors.lastname: van Heerbeek
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Sanders
authors.forename: Joost A M
authors.initials: JA
authors.lastname: Engel
authors.forename: Anne G M
authors.initials: AG
authors.lastname: Schilder
authors.forename: Ger T
authors.initials: GT
authors.lastname: Rijkers
authors.forename: Kees
authors.initials: K
authors.lastname: Graamans
authors.forename: Huub
authors.initials: H
authors.lastname: Straatman
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Zielhuis
mesh_terms: D015703:Antigens, CD / Q000097:blood / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005064:Eustachian Tube / Q000503:physiopathology*; D005260:Female; D005838:Genotype; D006801:Humans; D007136:Immunoglobulins / Q000097:blood*; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood; D008876:Middle Ear Ventilation; D015999:Multivariate Analysis; D010034:Otitis Media with Effusion / Q000276:immunology* / Q000503:physiopathology* / Q000601:surgery; D011312:Pressure; D011446:Prospective Studies; D017452:Receptors, IgG / Q000097:blood / Q000235:genetics; D012008:Recurrence; D012307:Risk Factors
chemical_list: D015703:Antigens, CD; C080568:Fc gamma receptor IIA; D007136:Immunoglobulins; D037601:Mannose-Binding Lectin; D017452:Receptors, IgG