The effect of the immune status and functional status of the Eustachian tube on the risk of recurrent exudative otitis media in children

The objective of a prospective cohort study by M. Straetemans et al. (Netherlands), was a study of the role of immune status and functional status of the Eustachian tube in the development of recurrent bilateral exudative otitis media (ESO) in children.

The study involved 136 children aged 2 to 7 years with a first clinical episode of bilateral ESO that lasted at least 3 months. When enrolling in the study, all patients underwent bilateral tympanostomy with a subsequent evaluation of the incidence of recurrence of bilateral otitis media after 6 months.

Analysis of various factors of the immune system (IgA, IgG1, IgG2, IgG3, IgG4, lectin binding mannose and the genotype FcgammaRIIa-H / R131) and the functional state of the Eustachian tube did not reveal any significant relationship between these indicators and recurrence episodes of bilateral otitis media. Additional multivariate analysis showed that children with closure pressure greater than 75% quartile and an IgA or IgG2 concentration less than 50% quartile of the cohort were more likely to develop recurrent exudative otitis media compared to children with closing pressure greater than 75% quartile and IgA or IgG2 is greater than 50% quartile. The relative risk was 6.3 (95% confidence interval [CI] 1-40.1) to reduce the concentration of IgA and 3 (95% CI 1.1-8.2) to reduce the concentration of IgG2. In a multivariate analysis, a relationship was also found between an increase in plasma concentrations of functional lectin binding mannose (participates in the immune response to the introduction of pathogens and interacts with macrophages) and a reduced risk of developing ESO recurrent (0.7; 95% CI 0.6-1.0).

Thus, the risk of recurrence of bilateral exudative otitis media after tympanostomy was higher in children with a combined decrease in the concentration of IgA or IgG2 and poor functional status of the Eustachian tube and a reduced concentration of lectin binding to mannose. Further research in this area will, according to the authors, allow the development of prognostic criteria for recurrence of ESF in clinical practice.