Dysregulation of immune response in otitis media

Abstract

Objective Otitis media (OM) is a common reason for children to be prescribed antibiotics and undergo surgery but a thorough understanding of disease mechanisms is lacking. We evaluate the evidence of a dysregulated immune response in the pathogenesis of OM. Methods A comprehensive systematic review of the literature using search terms [otitis media OR glue ear OR AOM OR OME] OR [middle ear AND (infection OR inflammation)] which were run through Medline and Embase via Ovid, including both human and animal studies. In total, 82 955 studies underwent automated filtering followed by manual screening. One hundred studies were included in the review. Results Most studies were based on in vitro or animal work. Abnormalities in pathogen detection pathways, such as Toll-like receptors, have confirmed roles in OM. The aetiology of OM, its chronic subgroups (chronic OM, persistent OM with effusion) and recurrent acute OM is complex; however, inflammatory signalling mechanisms are frequently implicated. Host epithelium likely plays a crucial role, but the characterisation of human middle ear tissue lags behind that of other anatomical subsites. Conclusions Translational research for OM presently falls far behind its clinical importance. This has likely hindered the development of new diagnostic and treatment modalities. Further work is urgently required; particularly to disentangle the respective immune pathologies in the clinically observed phenotypes and thereby work towards more personalised treatments.

17β‐estradiol Attenuates the Middle Ear Inflammatory Response to Nontypeable Haemophilus influenzae

“…The inflammatory cytokines TNFA, IL6, and IL8 regulate the expression of gel‐forming mucins during OM, 55 and ME mucin expression is correlated with hearing loss in OM patients 56 . Dysregulation of these pathways contributes to chronic OM through persistence or hypersecretion of mucins 5 . In addition to its potential to alter mucin expression secondary to cytokine suppression, chronic E2 exposure has been shown to regulate gel‐forming mucin expression via ER‐b and nuclear factor of activated T‐cell (NFAT) in bronchial cells 57 .…”

“…In some cases, OM may become recurrent (ROM) or chronic, and inflammatory effusion may persist even in absence of acute infection (OM with effusion, OME) conferring potential for developmental delays and extra‐ and intra‐cranial complications 4 . Dysregulation of the immune response is considered a predominant etiology of ROM and OME 5 . ME colonization by commensal organisms of the nasopharynx, Streptococcus pneumoniae , nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis , stimulates ME inflammatory cytokine release.…”

High TNF-α Levels in Active Phase Chronic Suppurative Otitis Media Caused by Gram-positive Bacteria

“…Low levels of TNF-α are found in the healthy body, and the level of this cytokine will increase in acute and chronic inflammatory conditions. 9,[20][21][22][23][24][25] There was no significant difference between blood serum and ear discharge TNF-α levels in patients with active phase CSOM. Therefore, the measurement of TNF-α levels in CSOM patients could be done both on blood serum samples and ear discharge.…”

A semi-quantitative visual lateral flow immunoassay for SARS-CoV-2 antibody detection for the follow-up of immune response to vaccination or recovery

“…1 It is widely employed for the indirect diagnosis of infectious diseases (e.g., HIV, 2,3 HCV, 4 syphilis, 5 Zika virus 6 and many others) and autoimmune diseases (e.g., hepatitis, 7 post-transfusion purpura and neonatal alloimmune thrombocytopenia, 8 systemic autoimmune rheumatic disease cardiac autoimmunity, 9,10 encephalitis, 11 and haemolytic anaemia 12 ), as well as for the monitoring of immunosuppression in organ transplants, 13,14 or other clinical immune-related pathologies. 15 It is also employed for the analysis of the acquired immunity from neutralizing antibodies, 16 for therapy monitoring 5 and for the extrapolation of information for vaccine design. 17 Immunoassays, based on the specific interaction between antigens and specific antibodies, are the most widely and routinely employed analytical techniques for this purpose in clinical laboratories.…”