Is the Healthy Middle Ear a Normally Sterile Site?

Westerberg, Brian D.; Kozak, Frederick K.; Thomas, Eva; Blondel-Hill, Edith; Brunstein, John; Patrick, David M.

doi:10.1097/mao.0b013e31819225a0

Cited by 22 publications

(14 citation statements)

References 14 publications

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“…It has been a long-held belief that the middle ear of a healthy individual is sterile (22,23). In contrast, the results from this study show a diverse bacterial community being detected in 45% of healthy mastoids and middle ears.…”

Section: Discussioncontrasting

confidence: 54%

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Molecular Microbiological Profile of Chronic Suppurative Otitis Media

et al. 2016

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bChronic suppurative otitis media (CSOM) presents with purulent otorrhea (ear discharge), is characterized by chronic inflammation of the middle ear and mastoid cavity, and contributes to a significant disease burden worldwide. Current antibiotic therapy is guided by swab culture results. In the absence of detailed molecular microbiology studies of CSOM patients, our current understanding of the microbiota of CSOM (and indeed of the healthy ear) remains incomplete. In this prospective study, 24 patients with CSOM were recruited, along with 22 healthy controls. Culture-based techniques and 16S rRNA gene amplicon sequencing were used to profile the bacterial community for each patient. Comparisons between patients with and without cholesteatoma in the middle ear and mastoid cavity were also made. A major finding was that the middle ear of many healthy controls was not sterile, which is contradictory to the results of previous studies. However, sequencing data showed that Staphylococcus aureus, along with a range of other Gram-positive and Gram-negative organisms, were present in all subgroups of CSOM and healthy controls. Large interpatient variability in the microbiota was observed within each subgroup of CSOM and controls, and there was no bacterial community "signature" which was characteristic of either health or disease. Comparisons of the culture results with the molecular data show that culture-based techniques underestimate the diversity of bacteria found within the ear. This study reports the first detailed examination of bacterial profiles of the ear in healthy controls and patients with CSOM.

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Section: Discussioncontrasting

confidence: 54%

“…It has previously been assumed that a healthy individual's ear is sterile (22,23). Infections in the middle ear are thought to occur when pathogens enter the middle ear through the external ear canal or Eustachian tube.…”

mentioning

confidence: 99%

Molecular Microbiological Profile of Chronic Suppurative Otitis Media

et al. 2016

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“…The middle ear is sterile according to specific PCR tests and bacterial cultures (32). However, Neeff et al detected bacteria with mass sequencing of samples from healthy adults’ middle ears in up to 43% of cases (15).…”

Section: Discussionmentioning

confidence: 99%

Next-Generation Sequencing Combined with Specific PCR Assays To Determine the Bacterial 16S rRNA Gene Profiles of Middle Ear Fluid Collected from Children with Acute Otitis Media

Sillanpää

Kramná

Oikarinen

et al. 2017

mSphere

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Although S. pneumoniae, H. influenzae, and M. catarrhalis have been long established as the most important pathogens in acute otitis media using culture and specific PCR assays, the knowledge of their mutual quantitative relations and possible roles of other bacteria is incomplete. The advent of unbiased bacteriome 16S rRNA gene profiling has allowed the detection of nearly all bacteria present in the sample, and it helps in depicting their mutual quantitative ratios. Due to the difficulties in performing mass sequencing in low-volume samples, only a few bacteriome-profiling studies of otitis media have been published, all limited to cases of chronic otitis media. Here, we present a study on samples obtained from young children with acute otitis media, successfully using a strategy of nested PCR coupled with mass sequencing, and demonstrate that the method can confer quantitative information hardly obtainable by other methods.

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“…To maintain a surface for gaseous exchange (Ar et al 2007) the middle ear is kept free of pathogens (Westerberg et al 2008) and particulate matter (and in this regard resembles the lung). Hence the antero-inferior region of the middle ear (including the Eustachian tube) is tasked with host defence (Ars & Ars-Piret 1997) and is lined with a lining that secretes and propels mucus to defend against bacterial ingress (Lim et al 2000).…”

Section: Evolution Of the Middle Earmentioning

confidence: 99%

Evolution and Otitis Media: A Review, and a Model to Explain High Prevalence in Indigenous Populations

Bhutta¹

2015

Human Biology

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Inflammation of the middle ear (otitis media) comprises a group of disorders that are highly prevalent in childhood, and indeed are amongst the most common disorders of childhood. Otitis media is also heritable, and has effects on fecundity. This means that otitis media is subject to evolution, yet the evolutionary selection forces that may determine susceptibility to otitis media have never been adequately explored.Here I undertake a critical analysis of evolutionary forces that may determine susceptibility to middle ear inflammation. These forces include those determining function of the middle ear, those affecting host immunity, and those affecting colonization by, and pathogenicity of bacteria. I review existing mathematical evolutionary models of host-pathogen interaction and co-evolution, and apply these to develop a better understanding of the complex evolutionary landscape of middle ear infection and inflammation in humans. This includes an understanding of factors Pre--print version. Visit http://digitalcommons.wayne.edu/humbiol/ after 1 October 2015 to acquire the final version.2 determining the transition between stable evolutionary strategies for host and bacterial pathogens. This understanding will be later applied to analysis of otitis media in indigenous populations.In the second part of this article, I apply the approach of population genetics to devise a new theory for the high prevalence of otitis media in certain indigenous populations: the Australian Aborigine, the Native American, the Inuit, and the Maori.I suggest that high prevalence in such groups may have occurred as a result of colonization of these previously isolated populations by European immigrants in the 15 th and 16 th Centuries. This exposed them to new strains of bacteria to which their immune system had not evolved immunity, perturbing a previously stable hostpathogen co-evolutionary state.

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Is the Healthy Middle Ear a Normally Sterile Site?

Abstract: The presumption that the healthy middle ear is colonized by bacteria from the nasopharynx is unsubstantiated.

Cited by 22 publications

References 14 publications

Molecular Microbiological Profile of Chronic Suppurative Otitis Media

Molecular Microbiological Profile of Chronic Suppurative Otitis Media

Next-Generation Sequencing Combined with Specific PCR Assays To Determine the Bacterial 16S rRNA Gene Profiles of Middle Ear Fluid Collected from Children with Acute Otitis Media

Evolution and Otitis Media: A Review, and a Model to Explain High Prevalence in Indigenous Populations

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