<p>Otitis media with effusion (OME) is the major form of chronic relapsing inflammatory disease of the middle ear, constitutes the most common diagnosis for children under 15 years old and is the major cause of auditory dysfunction in pre-school children. OME is a disease more commonly found in allergic children. These studies sought to investigate the inflammatory response in the middle ear of patients and test the hypothesis that an allergic-like response might occur in the ear. Atopy was diagnosed by standard in vitro tests. Immunochemical techniques used to study classic allergic rhinitis and asthma were extrapolated to the evaluation of OME children whose effusion persisted beyond 2 months. Not only eosinophil cationic protein (ECP), tryptase, CD3-positive and IL-5 producing cells, but also myeloperoxidase (MPO) was found in middle ear fluid and/or mucosa in the majority of patients with OME and atopy. </p><p>Initially, levels of ECP, MPO, and tryptase were measured in effusions from 97 random OME patients whose atopic status was determined by in vitro testing to 12 inhalants and 5 foods. The response of eosinophils, neutrophils and mast cells in the middle ear was distinctly different between atopic and non-atopic patients (p<0.001) with higher levels of the cell markers in the atopic group of patients. This suggested that 1) perhaps OME was predominantly a disease of atopics and that 2) they differed in their response from non-atopics.</p><p>Tryptase was measured in middle ear effusions from 38 patients with OME, 94.7% of whom were atopic by in vitro testing. Tryptase was elevated only in the effusion of atopic patients as compared to 5 controls (p<0.01). Biopsies stained histochemically for tryptase showed evidence of mast cells in the mucosa and submucosa from 6 of 8 OME ears but absent in 4 normals.</p><p>Middle ear biopsies, embedded in a plastic resin to improve the structural preservation, from 5 patients with OME and 5 normals were evaluated for the presence of eosinophils and neutrophils with monoclonal antibodies against 4 specific granule proteins. Eosinophils and neutrophils were present in the mucosa and mucus in significantly higher numbers than in the control group.</p><p>In an effort to determine whether the middle ear itself might be involved in allergic disease, evidence that some of the cells, mediators and cytokines associated specifically with a Th-2 response were sought for in the middle ear mucosa of these children. Middle ear biopsies from 7 atopic patients with OME and 4 controls demonstrated the presence of activated eosinophils, CD-3+ T cells and IL-5 mRNA cells only in the mucosa from atopic OME children. </p><p>Conclusion: Effusion and mucosal biopsies containing ECP, tryptase, and/or IL-5 mRNA cells, CD3+ T cells, eosinophils, and mast cells indicate that many of the mediators and cells essential to the production of a Th-2 immune mediated response are present in ears with chronic effusion. The increased levels of MPO in atopic patients further suggest that the general inflammatory response to putative inciting agents such as bacterial and viral products may be altered in atopy. These studies support the hypothesis that the exaggerated inflammation within the middle ear associated with most cases of OME is possibly the result of an atopic response within the middle ear itself.</p>

Otitis media with effusion (OME) is the major form of chronic relapsing inflammatory disease of the middle ear, constitutes the most common diagnosis for children under 15 years old and is the major cause of auditory dysfunction in pre-school children. OME is a disease more commonly found in allergic children. These studies sought to investigate the inflammatory response in the middle ear of patients and test the hypothesis that an allergic-like response might occur in the ear. Atopy was diagnosed by standard in vitro tests. Immunochemical techniques used to study classic allergic rhinitis and asthma were extrapolated to the evaluation of OME children whose effusion persisted beyond 2 months. Not only eosinophil cationic protein (ECP), tryptase, CD3-positive and IL-5 producing cells, but also myeloperoxidase (MPO) was found in middle ear fluid and/or mucosa in the majority of patients with OME and atopy. Initially, levels of ECP, MPO, and tryptase were measured in effusions from 97 random OME patients whose atopic status was determined by in vitro testing to 12 inhalants and 5 foods. The response of eosinophils, neutrophils and mast cells in the middle ear was distinctly different between atopic and non-atopic patients (p&lt;0.001) with higher levels of the cell markers in the atopic group of patients. This suggested that 1) perhaps OME was predominantly a disease of atopics and that 2) they differed in their response from non-atopics. Tryptase was measured in middle ear effusions from 38 patients with OME, 94.7% of whom were atopic by in vitro testing. Tryptase was elevated only in the effusion of atopic patients as compared to 5 controls (p&lt;0.01). Biopsies stained histochemically for tryptase showed evidence of mast cells in the mucosa and submucosa from 6 of 8 OME ears but absent in 4 normals. Middle ear biopsies, embedded in a plastic resin to improve the structural preservation, from 5 patients with OME and 5 normals were evaluated for the presence of eosinophils and neutrophils with monoclonal antibodies against 4 specific granule proteins. Eosinophils and neutrophils were present in the mucosa and mucus in significantly higher numbers than in the control group. In an effort to determine whether the middle ear itself might be involved in allergic disease, evidence that some of the cells, mediators and cytokines associated specifically with a Th-2 response were sought for in the middle ear mucosa of these children. Middle ear biopsies from 7 atopic patients with OME and 4 controls demonstrated the presence of activated eosinophils, CD-3+ T cells and IL-5 mRNA cells only in the mucosa from atopic OME children. Conclusion: Effusion and mucosal biopsies containing ECP, tryptase, and/or IL-5 mRNA cells, CD3+ T cells, eosinophils, and mast cells indicate that many of the mediators and cells essential to the production of a Th-2 immune mediated response are present in ears with chronic effusion. The increased levels of MPO in atopic patients further suggest that the general inflammatory response to putative inciting agents such as bacterial and viral products may be altered in atopy. These studies support the hypothesis that the exaggerated inflammation within the middle ear associated with most cases of OME is possibly the result of an atopic response within the middle ear itself.

Introduktion: Sekretorisk media otit (SOM) är den vanligaste öronsjukdomen och uppkommer oftast i efterförloppet till akut media otit (AOM). Om barnet får SOM leder det till hörselnedsättning som kan påverka språklig utveckling och ge beteendeproblem. Etiologin bakom SOM anses vara multifaktoriell. Barnets tryck i mellanörat kan påverkas vid flaskmatning. Allergier, bakteriella/virus infektioner och inflammationer har också betydelse för utvecklandet av SOM. Syfte: att studera frekvensen av att använda nappflaska och liggande position vid flaskmatning relaterat till sekretorisk media otit och akut media otit i samband med rörbehandling. Metod: En deskriptiv tvärsnittsstudie med kvantitativ ansats. Datainsamling skedde via enkäter som besvarades av närstående till barn 2- 5 år som genomgått rörinsättning på öronoperation. Resultat: 103 barn med närstående deltog i studien. 87% av barnen som genomgick rörinsättning använde eller hade använt nappflaska och av dessa barn låg 55% i planläge. Hereditet gällande SOM kunde skönjas. Konklusion: Studien visade hög frekvens av flaskmatning där lite mer än hälften, 55% låg i planläge men studiens begränsning kunde inte åskådligöra samband med planläge och SOM. Det är av vikt att belysa faktorer som har betydelse för utveckling av SOM för att minska behov av rörbehandling. Dessa faktorer kan sjuksköterskan informera närstående om via hälsoundervisning för att öka barn och närståendes empowerment. / Introduction: Otitis Media with Effusion (OME) is the most common ear disease and arises mostly in the end of akut media otit (AOM). If a child contracts OME, it will result in a hearing loss which can affect the verbal development and may lead to behavior difficulties. The etiology behind OME is considered to be multifactorial. A child’s middle ear pressure may be affected by bottle nursing. Furthermore, the development of OME may be caused by allergies, bacterial/virus infections and inflammations. Purpose: To study the frequency of using a feeding bottle while the child is lying down related to OME and AOM when tube insertion. Method: A descriptive cross-sectional study with a quantitative approach. A survey data collection was used wherein the people who were surveyed were close family to two to five year old children, who have had ear tubes inserted. Result: 103 children with their close family participated in the study. 90% of these children who went through an ear tube insertion used or had used a feeding bottle and 50% of them lied down as they were fed. The heredity regarding SOM could be picked out. Conclusion: The study showed a high frequency of bottle nursing where just over the half (55%) lied down, but the restriction of the study could however not visualize the relation between lying down and SOM. Moreover, it is important to bring up the factors that are significant for the development of SOM to decrease the need of ear tube treatment/insertion. The nurse can inform close family about these factors through health education in order to increase children and close family´s empowerment.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

A fissura labiopalatina é um indicador de risco para alterações de orelha média e estas podem prejudicar o desenvolvimento de habilidades auditivas como, por exemplo, a atenção, que é essencial para o aprendizado de novas habilidades, inclusive da comunicação oral e escrita. O estudo do processo atencional na população com fissura labiopalatina é algo recente e pouco explorado na literatura específica consultada, assim, este trabalho poderá contribuir com novos subsídios na área, uma vez que teve como objetivos: a) verificar o desempenho de crianças com essa anomalia craniofacial em dois testes, o THAAS e o teste dicótico de dígitos (etapa de escuta direcionada, que avaliaram processos de atenção auditiva); b) comparar o resultado com um grupo sem fissura labiopalatina e; c) verificar a associação entre os dois testes aplicados. Fizeram parte do estudo 55 crianças, de ambos os gêneros, na faixa etária de 7 anos a 7 anos e 11 meses, que foram distribuídas em dois grupos: a) grupo controle, formado por crianças sem fissura labiopalatina; b) grupo experimental, formado por crianças com fissura labiopalatina. Para ambos os grupos, o processo de avaliação constituiu-se em: aplicação de um questionário; bateria de testes auditivos convencionais; aplicação do teste da habilidade de atenção auditiva (THAAS) (FENIMAN, 2004) e do teste dicótico de dígitos etapa de escuta direcionada (SANTOS; PEREIRA, 1997). Foi possível observar que o desempenho do grupo com fissura labiopalatina foi inferior ao do grupo controle em todos os tipos de resposta do THAAS e diferença estatisticamente significativa ocorreu para o decréscimo da vigilâ (p=0,014). No teste dicótico de dígitos - etapa de escuta direcionada, o grupo com fissura labiopalatina apresentou porcentagens de acerto inferiores ao grupo controle, tanto para a orelha direita quanto para a orelha esquerda. A análise estatística mostrou interação estatisticamente significante entre grupo e gênero (p=0,026). Ao comparar o THAAS com o teste dicótico de dígitos, foi possível observar que existe associação entre os testes, mas, essa associação mostrou-se muito baixa (R²=0,27). As crianças com fissura labiopalatina apresentaram desempenho no THAAS inferior àquelas sem esta anomalia craniofacial, apenas para o decréscimo da vigilância. No teste dicótico de dígitos - etapa de escuta direcionada, somente as crianças do gênero feminino com fissura labiopalatina obtiveram índices de acerto inferiores às do grupo controle. Uma baixa associação foi verificada entre o THAAS e o teste dicótico de dígitos - etapa de escuta direcionada, permitindo supor que habilidades diferentes são responsáveis pelo desempenho nos dois testes. / Cleft lip and palate indicates risk to alterations in the middle ear. These risks may impair the development of some hearing abilities, such as attention, which is essential to learn new abilities, including oral and written communication. Studies on attention process with the population with cleft lip and palate are recent and not widely found in literature. Therefore, this study can contribute to the area. The aims of this study were to examine children with this craniofacial anomaly through two tests: The SAAAT and the Dichotic Digit test - directed hearing stage which evaluated the hearing attention processes; to compare the results with a group without cleft lip and palate; to verify the association between the two tests. 55 children, both genders, aged 7 to 7 years and 11 months old were divided in two groups to be submitted to the study. Experimental group consisted of children with cleft lip and palate and Control group consisted of children without it. Both groups were assessed through a questionnaire, conventional hearing tests battery, the Sustained Auditory Attention Ability test (SAAAT) (Feniman, 2004), and the Dichotic Digit test - directed hearing stage (Santos; Pereira, 1997). Experimental group showed lower performance than the control group in all kinds of answers of the SAAAT and, significant difference regarding decrease in vigilance (p=0,014). In the Dichotic Digit test the experimental group showed lower percentages of right answers than the control group, not only for the right ear but also for the left ear. Statistic analysis showed significant interaction between group and gender (p=0,026). When compared, the SAAAT and the Dichotic digit test had low association (R²=0,27). Experimental Group presented lower performance in the SAAAT only at the vigilance decrease. At the Dichotic Digit test female children with cleft lip and palate presented lower scores of right answers than the Control group. The SAAAT and The Dichotic Digit test - directed hearing stage - were not closely associated. Thus, it is possible to assume that different abilities are responsible for the performance in both tests.

A otite média, afecção comum na infância, acarreta uma perda auditiva condutiva flutuante, pois uma vez tratada os limiares auditivos voltam aos valores normais. Preocupação ocorre quando estes episódios tornam-se recorrentes levando a criança a receber uma estimulação sonora inconsistente do sistema nervoso auditivo central, dificultando a percepção dos sons da fala. O objetivo do presente estudo foi investigar se crianças com episódios recorrentes e comprovados de otite média com efusão apresentam alterações das habilidades auditivas que compõe o processamento auditivo. Foram avaliadas 59 crianças com idade entre 6 e 10 anos, divididas em dois grupos: grupo experimental composto por 29 crianças de ambos os gêneros com histórico documentado de otite media com efusão, perda auditiva condutiva nos primeiros anos de vida e com e sem história de cirurgia para colocação de tubo de ventilação na idade pré-escolar e escolar; e grupo controle, composto por 30 crianças, pareadas em idade e gênero com o grupo experimental, mas sem história da afecção. Na avaliação das habilidades auditivas que compõe o processamento auditivo foram utilizados o teste fala com ruído (TFR), teste dicótico de dígitos (TDD) e teste Gaps-in-noise (GIN). Todas as crianças no momento da avaliação estavam livres de perda auditiva condutiva. Os resultados mostraram que: os dois grupos não apresentavam diferenças dos limiares tonais, no momento da avaliação; o grupo experimental apresentou resultados inferiores no TFR e GIN, tanto na análise quantitativa quanto na qualitativa; o TDD apenas na análise qualitativa diferenciou os dois grupos. Pode-se concluir, no presente estudo, , que crianças com história de otite média com efusão recorrente e persistente, nas fases pré-escolar e escolar, apresentaram transtorno do processamento auditivo. / Otitis media, a common affection in childhood, causes a fluctuating conductive hearing loss, because once treated the hearing thresholds back to normal values. Concern occurs when these episodes become recurring leading the child to receive an inconsistent sound stimulation auditory central nervous system, it difficult for the perception of speech sounds. The aim of this study was to investigate whether children with recurrent episodes of proven otitis media with effusion present alterations of auditory skills that composes the auditory processing. We evaluated 59 children with ages between 6 and 10 years, divided into two groups: the experimental group comprised of 29 children of both genders with documented history of otitis media with effusion, conductive hearing loss in the early years of life and with and without history of surgery for ventilation tube placement in preschool and school age; and the control group, consisting of 30 children, paired in age and gender with the experimental group, but no history of the disease. In the assessment of auditory skills that make up the auditory processing was used Speech in Noise Test (SNT), Dichotic Digits Test (DDT) and Gaps in Noise test (GIN). All children had at the time of assessment were free of conductive hearing loss. The results showed that: the two groups showed no differences in tonal thresholds, at the time of the assessment; the experimental group showed results below the SNT and GIN, both in qualitative and in quantitative analysis; DDT only in qualitative analysis differentiated the two groups. It can be concluded, with the results of the work, that children with a history of otitis media with effusion recurrent and persistent, pre-school and school phases, may have auditory processing disorder.

Otitis media (OM), one of the commonest of childhood diseases, causes much suffering. OM exists in a variety of forms, two of which are acute otitis media (AOM) and otitis media with effusion (OME). The clinical courses of these conditions differ, AOM usually presenting with earache, fever and/or aural discharge, and the OME usually with hearing impairment. The tympanic membrane (TM) mirrors the events in the middle ear cavity, and pars flaccida (PF) is the initial site of inflammatory changes in the TM. PF is rich in mast cells (MCs), which by releasing various mediators, may trigger TM inflammation. The aims of the present studies were to investigate early inflammatory changes in the TM in rat models of OM; after mast cell degranulation, in response to AOM, and OME, after myringotomy in AOM and in normal ears. Furthermore, we developed a new rat AOM model, that excludes surgical trauma and resembles the natural route of infection in man. AOM and OME elicited the first inflammatory response in PF of the TM. The response to OME was discrete, but a slight increase in macrophages was found. During the first 48 hours of AOM, the inflammatory response was intense, following a bimodal pattern. This reaction is similar to that found after MC degranulation. In AOM, macrophages were the predominant cell in PF, while in pars tensa (PT), polymorphonuclear cells (mainly neutrophils) predominated. When myringotomy was performed in AOM ears, the healing time was shorter than that of myringotomy in normal ears. The highly inflamed lamina propria seemed to promote healing. During early AOM, as well as following myringotomy, fibrin extravasates into PF and PT. This fibrin deposition may be involved in regulating the inflammatory response. Repeated nasal challenge with the otitis media pathogen Streptococcus pneumoniae provoked AOM and concomitant TM stimulation reduced the number of AOM cases. This new rat AOM model has the advantage of avoiding trauma in the middle ear cavity, while eliciting an intense inflammatory response in the middle ear cavity (MEC).

A otite média, afecção comum na infância, acarreta uma perda auditiva condutiva flutuante, pois uma vez tratada os limiares auditivos voltam aos valores normais. Preocupação ocorre quando estes episódios tornam-se recorrentes levando a criança a receber uma estimulação sonora inconsistente do sistema nervoso auditivo central, dificultando a percepção dos sons da fala. O objetivo do presente estudo foi investigar se crianças com episódios recorrentes e comprovados de otite média com efusão apresentam alterações das habilidades auditivas que compõe o processamento auditivo. Foram avaliadas 59 crianças com idade entre 6 e 10 anos, divididas em dois grupos: grupo experimental composto por 29 crianças de ambos os gêneros com histórico documentado de otite media com efusão, perda auditiva condutiva nos primeiros anos de vida e com e sem história de cirurgia para colocação de tubo de ventilação na idade pré-escolar e escolar; e grupo controle, composto por 30 crianças, pareadas em idade e gênero com o grupo experimental, mas sem história da afecção. Na avaliação das habilidades auditivas que compõe o processamento auditivo foram utilizados o teste fala com ruído (TFR), teste dicótico de dígitos (TDD) e teste Gaps-in-noise (GIN). Todas as crianças no momento da avaliação estavam livres de perda auditiva condutiva. Os resultados mostraram que: os dois grupos não apresentavam diferenças dos limiares tonais, no momento da avaliação; o grupo experimental apresentou resultados inferiores no TFR e GIN, tanto na análise quantitativa quanto na qualitativa; o TDD apenas na análise qualitativa diferenciou os dois grupos. Pode-se concluir, no presente estudo, , que crianças com história de otite média com efusão recorrente e persistente, nas fases pré-escolar e escolar, apresentaram transtorno do processamento auditivo. / Otitis media, a common affection in childhood, causes a fluctuating conductive hearing loss, because once treated the hearing thresholds back to normal values. Concern occurs when these episodes become recurring leading the child to receive an inconsistent sound stimulation auditory central nervous system, it difficult for the perception of speech sounds. The aim of this study was to investigate whether children with recurrent episodes of proven otitis media with effusion present alterations of auditory skills that composes the auditory processing. We evaluated 59 children with ages between 6 and 10 years, divided into two groups: the experimental group comprised of 29 children of both genders with documented history of otitis media with effusion, conductive hearing loss in the early years of life and with and without history of surgery for ventilation tube placement in preschool and school age; and the control group, consisting of 30 children, paired in age and gender with the experimental group, but no history of the disease. In the assessment of auditory skills that make up the auditory processing was used Speech in Noise Test (SNT), Dichotic Digits Test (DDT) and Gaps in Noise test (GIN). All children had at the time of assessment were free of conductive hearing loss. The results showed that: the two groups showed no differences in tonal thresholds, at the time of the assessment; the experimental group showed results below the SNT and GIN, both in qualitative and in quantitative analysis; DDT only in qualitative analysis differentiated the two groups. It can be concluded, with the results of the work, that children with a history of otitis media with effusion recurrent and persistent, pre-school and school phases, may have auditory processing disorder.

Introdução: A etiologia da otite média com efusão ainda não está completamente estabelecida, mas agentes infecciosos podem contribuir para sua patogênese. Demonstrou-se que a reação em cadeia da polimerase (PCR) é superior ao exame cultural para detectar espécies bacterianas. O conhecimento sobre a epidemiologia bacteriana da otite média com efusão em áreas geográficas distintas é essencial para a implementação de tratamentos racionais, quando necessários. Objetivos: Determinar a prevalência do Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis e Alloiococcus otitidis nas efusões de orelha média de crianças com otite média recorrente e otite média com efusão crônica que foram submetidas à miringotomia, comparar os resultados obtidos por cultura e PCR, comparar os achados bacteriológicos em crianças menores e maiores de dois anos e determinar o perfil de resistência à penicilina dos germes isolados. Métodos: Analisaram-se 128 amostras de efusões de orelha média de 75 crianças entre 11 meses e 9 anos e 4 meses de idade (média = 34,7 meses). Pacientes com otite média recorrente tinham efusão documentada por ≥ 6 semanas e aqueles com otite média com efusão crônica, por ≥3 meses. Os pacientes não tinham sinais de otite média aguda ou infecção do trato respiratório e não estavam sob antibioticoterapia no momento do procedimento. A aspiração do material foi realizada por timpanocentese, utilizando-se um coletor de Alden-Senturia. Os estudos bacteriológicos foram iniciados em menos de 15 minutos após a obtenção da efusão e uma parte da amostra foi armazenada a -20oC para análise posterior pela PCR. Utilizou-se um método de PCR simultânea para a detecção de quatro patógenos. A análise estatística foi efetivada com o teste χ2 de McNemar, teste χ2 com correção de Yates e teste exato de Fisher, quando apropriados. Resultados: Cultivaram-se bactérias em 32 (25,1%) das 128 amostras e os patógenos principais foram encontrados em 25 (19,6%). O A. otitidis não foi isolado em cultura. A PCR identificou bactérias em 110 (85,9%) das amostras, e os resultados positivos foram: 67 (52,3%) para A. otitidis, 50 (39,1%) para H. influenzae, 16 (12,5%) para S. pneumoniae e 13 (10,2%) para M. catarrhalis. Todas as amostras positivas por cultura foram positivas pela PCR, mas 85 (77,2%) das efusões com resultado positivo pela PCR foram negativas por cultura, para os germes estudados. A PCR foi significativamente mais sensível que a cultura (P<0,001). O S. pneumoniae foi encontrado mais freqüentemente em otite média recorrente do que em otite média com efusão crônica (P=0,038) e o H. influenzae foi encontrado mais vezes em crianças menores de dois anos (P=0,049). Quanto ao perfil de resistência, 100% das M. catarrhalis, 62,5% dos S. pneumoniae e 23% dos H. influenzae eram resistentes à penicilina. Conclusões: A prevalência das bactérias na otite média com efusão em um grupo de crianças brasileiras é semelhante àquelas relatadas em outros países, sendo o H. influenzae o mais encontrado dentre os patógenos principais da orelha média. Essa prevalência sugere que bactérias podem desempenhar um papel na patogênese da otite média com efusão. Os resultados mostram que a PCR é mais sensível na detecção de bactérias na efusão da orelha média, comparada com cultura, e é essencial para a identificação do A. otitidis. O elevado percentual de detecção do A. otitidis sugere mais investigações sobre sua atuação no início e no prolongamento de doenças da orelha média. O S. pneumoniae foi mais freqüente em otite média recorrente do que em otite média com efusão crônica e o H. influenzae foi mais encontrado em crianças menores de dois anos. A resistência à penicilina por parte do pneumococo e da moraxela é semelhante à relatada em outros países, ao passo que a produção de β-lactamase pelo hemófilo é mais baixa que aquela referida em bactérias isoladas em amostras de efusões de otite média com efusão. / Background: The etiology of otitis media with effusion is still unclear but infective agents may contribute to its pathogenesis. Polymerase chain reaction (PCR) has been shown to have a superior ability in detecting bacterial species, when compared to conventional culture methods. The knowledge of the bacteriological epidemiology of otitis media with effusion in different geographical areas is crucial for the implementation of rational treatment in selected cases. Objectives: To determine the prevalence of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Alloiococcus otitidis in the middle ear effusion of children with recurrent otitis media and chronic otitis media with effusion undergoing miryngotomy, to compare the results obtained by culture and PCR, to compare the bacteriological findings in children younger and older than two years of age, and to determine the susceptibility to penicillin of the bacterial isolates. Methods: A total of 128 middle ear effusion samples from 75 children aged 11 months to 9 years and 4 months (mean = 34.7 months) were analyzed. Patients with recurrent otitis media had documented middle ear effusion for ≥ 6 weeks, and chronic otitis media with effusion for ≥ 3 months. Patients had no signs of acute otitis media or respiratory tract infection and were not on antibiotics. Aspiration was done through tympanocentesis with an Alden-Senturia trap. Bacteriological studies were initiated in less than 15 minutes after acquisition of the effusion and a part of the sample was stored frozen at -20oC for latter PCR analysis. Multiplex PCR methods for the detection of four pathogens were used. Statistical analyses were done using McNemar´s χ2 test, χ2 test with Yates’ correction, and Fisher’s exact test, when appropriate. Results: Bacteria were cultured in 32 (25.1%) of the 128 samples and the major pathogens were found in 25 (19.6%). A. otitidis was not detected by culture. PCR yielded positive for bacteria in 110 (85.9%) of the samples and these positive PCR results were: 67 (52.3%) for A. otitidis, 50 (39.1%) for H. influenzae, 16 (12.5%) for S. pneumoniae, and 13 (10.2%) for M. catarrhalis. All the culture-positive samples were PCR-positive but 85 (77.2%) of the PCR-positive specimens were culture-negative. PCR was significantly more sensitive than culture (P<0.01). S. pneumoniae was more frequently found in samples from recurrent otitis media when compared to chronic otitis media with effusion (P=0.038) and H. influenzae was more prevalent in children younger than two years when compared to the older group (P=0.049). The resistance to penicillin was: M. catarrhalis = 100%; S. pneumoniae = 62.5% and H. influenzae = 23% of the isolates. Conclusions: The prevalence of bacteria in otitis media with effusion in a group of Brazilian children is similar to that reported from other countries, and H. influenzae is the most frequently found microorganism among the main middle ear pathogens. This prevalence suggests that bacteria may play a role in the pathogenesis of otitis media with effusion. Also PCR is more sensitive in detecting bacteria in the middle ear effusion, compared to conventional culture methods, and is essential for the detection of A. otitidis. The high recovery rate of A. otitidis warrants further investigation of its role in initiating or prolonging middle ear disease. S. pneumoniae was more frequently found in recurrent otitis media compared to chronic otitis media with effusion and H. influenzae was more prevalent in children younger than two years of age. Pneumococcal and moraxella´s resistance to penicillin is similar to but hemophillus’ β-lactamase production is lower than that reported from other countries when bacteria isolated from middle ear effusion samples of otitis media with effusion were analyzed.

Introdução: A etiologia da otite média com efusão ainda não está completamente estabelecida, mas agentes infecciosos podem contribuir para sua patogênese. Demonstrou-se que a reação em cadeia da polimerase (PCR) é superior ao exame cultural para detectar espécies bacterianas. O conhecimento sobre a epidemiologia bacteriana da otite média com efusão em áreas geográficas distintas é essencial para a implementação de tratamentos racionais, quando necessários. Objetivos: Determinar a prevalência do Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis e Alloiococcus otitidis nas efusões de orelha média de crianças com otite média recorrente e otite média com efusão crônica que foram submetidas à miringotomia, comparar os resultados obtidos por cultura e PCR, comparar os achados bacteriológicos em crianças menores e maiores de dois anos e determinar o perfil de resistência à penicilina dos germes isolados. Métodos: Analisaram-se 128 amostras de efusões de orelha média de 75 crianças entre 11 meses e 9 anos e 4 meses de idade (média = 34,7 meses). Pacientes com otite média recorrente tinham efusão documentada por ≥ 6 semanas e aqueles com otite média com efusão crônica, por ≥3 meses. Os pacientes não tinham sinais de otite média aguda ou infecção do trato respiratório e não estavam sob antibioticoterapia no momento do procedimento. A aspiração do material foi realizada por timpanocentese, utilizando-se um coletor de Alden-Senturia. Os estudos bacteriológicos foram iniciados em menos de 15 minutos após a obtenção da efusão e uma parte da amostra foi armazenada a -20oC para análise posterior pela PCR. Utilizou-se um método de PCR simultânea para a detecção de quatro patógenos. A análise estatística foi efetivada com o teste χ2 de McNemar, teste χ2 com correção de Yates e teste exato de Fisher, quando apropriados. Resultados: Cultivaram-se bactérias em 32 (25,1%) das 128 amostras e os patógenos principais foram encontrados em 25 (19,6%). O A. otitidis não foi isolado em cultura. A PCR identificou bactérias em 110 (85,9%) das amostras, e os resultados positivos foram: 67 (52,3%) para A. otitidis, 50 (39,1%) para H. influenzae, 16 (12,5%) para S. pneumoniae e 13 (10,2%) para M. catarrhalis. Todas as amostras positivas por cultura foram positivas pela PCR, mas 85 (77,2%) das efusões com resultado positivo pela PCR foram negativas por cultura, para os germes estudados. A PCR foi significativamente mais sensível que a cultura (P<0,001). O S. pneumoniae foi encontrado mais freqüentemente em otite média recorrente do que em otite média com efusão crônica (P=0,038) e o H. influenzae foi encontrado mais vezes em crianças menores de dois anos (P=0,049). Quanto ao perfil de resistência, 100% das M. catarrhalis, 62,5% dos S. pneumoniae e 23% dos H. influenzae eram resistentes à penicilina. Conclusões: A prevalência das bactérias na otite média com efusão em um grupo de crianças brasileiras é semelhante àquelas relatadas em outros países, sendo o H. influenzae o mais encontrado dentre os patógenos principais da orelha média. Essa prevalência sugere que bactérias podem desempenhar um papel na patogênese da otite média com efusão. Os resultados mostram que a PCR é mais sensível na detecção de bactérias na efusão da orelha média, comparada com cultura, e é essencial para a identificação do A. otitidis. O elevado percentual de detecção do A. otitidis sugere mais investigações sobre sua atuação no início e no prolongamento de doenças da orelha média. O S. pneumoniae foi mais freqüente em otite média recorrente do que em otite média com efusão crônica e o H. influenzae foi mais encontrado em crianças menores de dois anos. A resistência à penicilina por parte do pneumococo e da moraxela é semelhante à relatada em outros países, ao passo que a produção de β-lactamase pelo hemófilo é mais baixa que aquela referida em bactérias isoladas em amostras de efusões de otite média com efusão. / Background: The etiology of otitis media with effusion is still unclear but infective agents may contribute to its pathogenesis. Polymerase chain reaction (PCR) has been shown to have a superior ability in detecting bacterial species, when compared to conventional culture methods. The knowledge of the bacteriological epidemiology of otitis media with effusion in different geographical areas is crucial for the implementation of rational treatment in selected cases. Objectives: To determine the prevalence of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Alloiococcus otitidis in the middle ear effusion of children with recurrent otitis media and chronic otitis media with effusion undergoing miryngotomy, to compare the results obtained by culture and PCR, to compare the bacteriological findings in children younger and older than two years of age, and to determine the susceptibility to penicillin of the bacterial isolates. Methods: A total of 128 middle ear effusion samples from 75 children aged 11 months to 9 years and 4 months (mean = 34.7 months) were analyzed. Patients with recurrent otitis media had documented middle ear effusion for ≥ 6 weeks, and chronic otitis media with effusion for ≥ 3 months. Patients had no signs of acute otitis media or respiratory tract infection and were not on antibiotics. Aspiration was done through tympanocentesis with an Alden-Senturia trap. Bacteriological studies were initiated in less than 15 minutes after acquisition of the effusion and a part of the sample was stored frozen at -20oC for latter PCR analysis. Multiplex PCR methods for the detection of four pathogens were used. Statistical analyses were done using McNemar´s χ2 test, χ2 test with Yates’ correction, and Fisher’s exact test, when appropriate. Results: Bacteria were cultured in 32 (25.1%) of the 128 samples and the major pathogens were found in 25 (19.6%). A. otitidis was not detected by culture. PCR yielded positive for bacteria in 110 (85.9%) of the samples and these positive PCR results were: 67 (52.3%) for A. otitidis, 50 (39.1%) for H. influenzae, 16 (12.5%) for S. pneumoniae, and 13 (10.2%) for M. catarrhalis. All the culture-positive samples were PCR-positive but 85 (77.2%) of the PCR-positive specimens were culture-negative. PCR was significantly more sensitive than culture (P<0.01). S. pneumoniae was more frequently found in samples from recurrent otitis media when compared to chronic otitis media with effusion (P=0.038) and H. influenzae was more prevalent in children younger than two years when compared to the older group (P=0.049). The resistance to penicillin was: M. catarrhalis = 100%; S. pneumoniae = 62.5% and H. influenzae = 23% of the isolates. Conclusions: The prevalence of bacteria in otitis media with effusion in a group of Brazilian children is similar to that reported from other countries, and H. influenzae is the most frequently found microorganism among the main middle ear pathogens. This prevalence suggests that bacteria may play a role in the pathogenesis of otitis media with effusion. Also PCR is more sensitive in detecting bacteria in the middle ear effusion, compared to conventional culture methods, and is essential for the detection of A. otitidis. The high recovery rate of A. otitidis warrants further investigation of its role in initiating or prolonging middle ear disease. S. pneumoniae was more frequently found in recurrent otitis media compared to chronic otitis media with effusion and H. influenzae was more prevalent in children younger than two years of age. Pneumococcal and moraxella´s resistance to penicillin is similar to but hemophillus’ β-lactamase production is lower than that reported from other countries when bacteria isolated from middle ear effusion samples of otitis media with effusion were analyzed.