Immune status and eustachian tube function in recurrence of otitis media with effusion.
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.
Straetemans
Masja
M
Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, the Netherlands.
van Heerbeek
Niels
N
Sanders
Elisabeth A M
EA
Engel
Joost A M
JA
Schilder
Anne G M
AG
Rijkers
Ger T
GT
Graamans
Kees
K
Straatman
Huub
H
Zielhuis
Gerhard A
GA
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
D015703:Antigens, CD; C080568:Fc gamma receptor IIA; D007136:Immunoglobulins; D037601:Mannose-Binding Lectin; D017452:Receptors, IgG