Highlights
- •AOM cases, when microbiologically-confirmed, reveal a unique otitis prone cohort.
- •Otitis proneness in children may result from multiple, transient immune dysfunction.
- •Nasopharyngeal and systemic immune compartments may display dysfunction.
- •Innate and adaptive immune systems may display dysfunction.
- •The immune profile of young otitis prone children may resemble that of a neonate.
Abstract
Acute Otitis Media (AOM) is a multifactorial disease occurring mostly in young children
who are immunologically naïve to AOM pathogens. This review focuses on work from Rochester
NY, USA over the past 12 years among young children who had AOM infections microbiologically-confirmed
by tympanocentesis, so called “stringently-defined”. Among stringently-defined otitis
prone children deficiencies in fundamental immune defense mechanisms have been identified
that contribute to the propensity of young children to experience recurrent AOM. Dysfunction
in innate immune responses that cause an immunopathological impact in the nasopharynx
have been discovered including inadequate proinflammatory cytokine response and poor
epithelial cell repair. Adaptive immunity defects in B cell function and immunologic
memory resulting in low levels of antibody to otopathogen-specific antigens allows
repeated infections. CD4+ and CD8+ T cell function and memory defects significantly
contribute. The immune profile of an otitis prone child resembles that of a neonate
through the first year of life. Immunologic deficits in otitis prone children cause
them to be unusually vulnerable to viral upper respiratory infections and respond
inadequately to routine pediatric vaccines.
Keywords
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Article info
Publication history
Published online: March 20, 2020
Accepted:
March 15,
2020
Identification
Copyright
© 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
