Otitis media as a presenting complaint in childhood immunodeficiency diseases

Abstract

Otitis media is one of the most common childhood infections and may result from a variety of underlying problems. Suspicion of immunodeficiency should increase when ear infections are frequent; suppurative; unresponsive to antibiotics; caused by unusual organisms; or seen in the context of other frequent infections, severe eczema, or failure to thrive. Humoral immune deficiencies, particularly with an inability to make antibody to encapsulated organisms, are the immunodeficiencies most likely to cause increased otitis media. Immune system evaluation should concentrate on humoral immunodeficiency disorders, but the presenting history and physical findings also should be considered when designing the work-up. Treating the underlying immune deficiency is usually necessary to adequately control the ear infections.

Otitis media

“…3). Host factors that increase the risk of OM include: young age 32 , male sex 33 , race and ethnicity 33 , genetic factors and a family history of OM 34 , craniofacial anomaly such as cleft palate 35 , atopy 34 , immunodeficiency 36 , upper respiratory tract infections (URTIs) and adenoid hypertrophy 34,37 , and laryngopharyngeal reflux 38 . Environmental factors that increase the risk of OM include: low socioeconomic status, exposure to tobacco smoke 34 , having older siblings 39 , day-care attendance 32,39,40 and the use of a pacifier 41,42 .…”

Otitis Media

“…The association of these factors with AOM was best accounted for by the strong correlation with attendance at large (≥ 20 children) daycare centers as well as short duration of breastfeeding. 7 Specific conditions such as Down's syndrome, craniofacial anomalies, 28,29 ciliary dyskinesia syndromes and primary and secondary immune deficiency syndromes [30][31][32] are associated with increased risks of AOM (Box 25-2). The estimate of discordance of AOM in monozygotic twins was 0.04 compared with 0.49 in dizygotic twins (P < .005).…”

Middle Ear and Eustachian Tube Mucosal Immunology

“…Subsequent studies, however, do support a relationship between the concentration of specific antibody responses following natural exposure to common otopathogens in serum and MEF in children who are prone to recurrent AOM (Berman et al, 1992;Sharma et al, 2011;Straetemans et al, 2005). Indeed, rapid inactivation and clearance of pathogenic bacteria are observed in children where elevated specific serum antibodies, particularly IgG, are identified (Freijd et al, 1985); however, recurrent OM remains a key clinical indicator for identifying children with potential immunodeficiency (Wilson and Hogan, 2008).…”