Influenza A Virus-Induced Acute Otitis Media

Abstract

To better understand the significance of viral upper respiratory tract infections in the pathogenesis of acute otitis media (OM), 27 adults underwent intranasal inoculation with influenza A virus. Monitoring consisted of antibody titer determination, tympanometry, and otoscopy. Microbiologic analysis consisted of cultures and polymerase chain reaction (PCR)-based detection for influenza A virus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. All subjects became infected with the challenge virus. By day 4, 16 (59%) developed middle ear pressures of -100 mm H2O or below and 4 (25%) of them developed OM. One subject (4%) developed purulent OM requiring myringotomy for pain relief. Middle ear effusion cultures were negative. PCR analysis of that subject's middle ear effusion and nasal washes were positive for influenza A virus and S. pneumoniae. These findings support a causal role for viral upper respiratory tract infections in the pathogenesis of OM, possibly mediated by middle ear underpressures and viral and bacterial middle ear infection.

Otitis Media in Greenland: studies on historical, epidemiological, microbiological, and immunological aspects

“…Viruses have been found in coexistence with potentially pathogenic bacteria in 10 -30% of middle ear fluids and in the nasopharynx of 30 -55% of children with AOM (Henderson et al 1982, Arola et al 1990, Ruuskanen et al 1991. Especially influenza A and B virus and respiratory syncytial virus (RSV) seem to be independent pathogens inAOM (Henderson et al 1982, Klein et al 1982, Arola et al 1990, Ruuskanen et al 1991, Buchman et al 1995. The objectives of the present studies were therefore to determine the bacterial and viral microflora in the nasopharynx of healthy Greenlandic children and in children with and without AOM including the pathogens in ear discharge.…”

Expression of Cytokine and Chemokine Genes by Human Middle Ear Epithelial Cells Induced by Influenza A Virus andStreptococcus pneumoniaeOpacity Variants

“…The transparent variant demonstrates an increased ability to adhere to respiratory epithelial cells, while the opaque phenotype is decidedly more virulent (24). Our laboratory recently demonstrated that there is a relationship between an antecedent influenza virus infection and the ability of an S. pneumoniae strain with the opaque phenotype to persist and to induce OM in the chinchilla model (41).Considerable epidemiologic, clinical, and laboratory evidence suggests that influenza A virus promotes S. pneumoniaeinduced OM (6,16,21). Several possible mechanisms have been proposed to explain this phenomenon, including viral compromise of eustachian tube mucosal integrity (resulting in an impaired clearance function and the development of negative middle ear pressure) and viral suppression of polymorphonuclear leukocyte function (1,9,17,30,31).…”

“…Considerable epidemiologic, clinical, and laboratory evidence suggests that influenza A virus promotes S. pneumoniaeinduced OM (6,16,21). Several possible mechanisms have been proposed to explain this phenomenon, including viral compromise of eustachian tube mucosal integrity (resulting in an impaired clearance function and the development of negative middle ear pressure) and viral suppression of polymorphonuclear leukocyte function (1,9,17,30,31).…”

Comparison of Alteration of Cell Surface Carbohydrates of the Chinchilla Tubotympanum and Colonial Opacity Phenotype of Streptococcus pneumoniae during Experimental Pneumococcal Otitis Media with or without an Antecedent Influenza A Virus Infection

“…The opaque phenotype was predominant among the pneumococcus isolates from the middle-ear fluid in the cohort infected with the both pathogens. Together, these data suggest that the synergic effect of influenza A virus and S. pneumoniae on the changes of the carbohydrate moieties in the ET epithelium and that the selection of the opaque variant may facilitate the pneumococcal invasion of the middle ear.Considerable epidemiologic, clinical, and laboratory evidence suggests that influenza A virus promotes Streptococcus pneumoniae-induced otitis media (OM) (4,5,6,10,12,23). Several possible mechanisms have been proposed to explain this phenomenon, including viral compromise of eustachian tube (ET) mucosal integrity, resulting in impaired clearance function with the development of negative middle ear pressure, and viral suppression of polymorphonuclear leukocyte function (1,2,7,11,18,19).…”