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14. Immunological mechanism of recurrent acute otitis media
290
Abstracts
(3) Sinus and mastoid radiographs have been carried out on 21 cases of unilateral OME. The sinus films were suggestive of bilateral sinusitis. There was no apparent relationship between the findings in the affected unilateral ears and the maxillary sinuses of the same side. Also there was no evidence of improvement of unilateral OME when the sinus infection was successfully treated. It does not appear that unilateral sinus infection is an important cause of unilateral OME. (4) Mastoid pneumatization in the affected ears was prohibited, on the other hand, the normal ears had well-developed mastoid cells. There had been statistically significant differences in the pneumatization between the affected ears and the normal ears (P < O.OOS), 2 or 3 years before the onset of OME. (5) It is hypothesized that silent inflammation in the unilateral mastoid ceils persisting several years causes inhibition of the pneumatization results in unilateral OME.
13. Development
Yukako
of mastoid pneumatization
Imamuraa,
Toshimi
Mizutanib,
of the children with Down’s
Yukiko
syndrome
Iino”
aDepartment of otorhinolaryngology, Teikyo University Mizonokuchi Hospital; bDepartment of otorhinolaryngology, Teikyo University Ichihara Hospital; ‘Department of otorhinolaryngology, Teikyo University school of medicine
Recently we reported that in children with Down’s syndrome the incidence of otitis media with effusion was higher and the condition lasted longer than in normal children. In this study, we measured the size of mastoid pneumatized area and compared between children with Down’s syndrome and control group children with and without middle ear effusion. Children without OME showed good pneumatization. There was less mastoid pneumatization in children with Down’s syndrome than in the control group. The children with OME showed poor development of mastoid pneumatization in the control group as well as in the Down’s syndrome group. However, the pneumatized mastoid developed with age in the control group, but hardly developed in the children with Down’s syndrome. From these results, we concluded that early diagnosis of OME and appropriate treatments are needed for children with Down’s syndrome. Furthermore temporal bone CT image seems to be one of the best ways to predict the clinical course of OME and to decide on optimum approach to therapy in children with Down’s syndrome.
14. Immunological
Noboru
mechanism of recurrent
acute otitis
media
Yamanaka
Department of Otolaryngology, Wakayama Medical College
Abstracts
291
Some children are subject to recurrent episodes of otitis media. At least 45% of children have three or more episodes by 3 years of age and up to 16% experience six or more episodes. Three bacterial species - Streptococcus pneurnoniae (SP), nontypable Haemophilus inflzlenzae (NTHI), Moraxella catarrhalis (MC) - account for the majority of identifiable bacterial causes of acute otitis media (AOM). Nontypable H. injluenzae is an increasingly frequent cause of otitis media in children. Infection with nontypable H. injbenzae is associated with strain specific immunity. Protective antibodies are directed against several outer membrane proteins. One specific protein, P6, is highly conserved between strains and antigenitally stable and has been proposed as a possible candidate for vaccine formulation. In the study of the systemic immune response to P6 of nontypable H. influenzae, otitis-prone children did not exhibit the same age-related rise in anti-P6 antibody as seen in nonotitis prone children and that otitis-prone children may not recognize P6 protein as a major immunogen in otitis media due to nontypable H. infuenzae. In the study of local immune response to NTHI, local antibody to the P6 protein in the outer membrane of nontypable H. injluenzae was detected in middle ear fluids of 94% of children with otitis media. IgG was the immunoglobulin class of specific antibody observed in highest concentrations. The strong correlation between serum antibody and middle ear antibody suggested that the antibody in middle ear fluid probably represented leakage of serum antibody into the middle ear space across an inflamed middle ear mucosa. Thus, during the early phase of otitis media with nontypable H. influenzae, a child manifests a systemic immune response, comprised in part of antibody to P6, and the antibody passes into the middle ear to kill the bacteria. Secretory IgA specific for P6 locally produced in the middle ear was of much smaller amount compared to IgG. It seemed, however, to be important in the protection of bacterial growth in the middle ear, since the positive rate and the concentration of P6 specific secretory IgA were both significantly higher in children without nontypable H. injluenzae.
Abstracts
(3) Sinus and mastoid radiographs have been carried out on 21 cases of unilateral OME. The sinus films were suggestive of bilateral sinusitis. There was no apparent relationship between the findings in the affected unilateral ears and the maxillary sinuses of the same side. Also there was no evidence of improvement of unilateral OME when the sinus infection was successfully treated. It does not appear that unilateral sinus infection is an important cause of unilateral OME. (4) Mastoid pneumatization in the affected ears was prohibited, on the other hand, the normal ears had well-developed mastoid cells. There had been statistically significant differences in the pneumatization between the affected ears and the normal ears (P < O.OOS), 2 or 3 years before the onset of OME. (5) It is hypothesized that silent inflammation in the unilateral mastoid ceils persisting several years causes inhibition of the pneumatization results in unilateral OME.
13. Development
Yukako
of mastoid pneumatization
Imamuraa,
Toshimi
Mizutanib,
of the children with Down’s
Yukiko
syndrome
Iino”
aDepartment of otorhinolaryngology, Teikyo University Mizonokuchi Hospital; bDepartment of otorhinolaryngology, Teikyo University Ichihara Hospital; ‘Department of otorhinolaryngology, Teikyo University school of medicine
Recently we reported that in children with Down’s syndrome the incidence of otitis media with effusion was higher and the condition lasted longer than in normal children. In this study, we measured the size of mastoid pneumatized area and compared between children with Down’s syndrome and control group children with and without middle ear effusion. Children without OME showed good pneumatization. There was less mastoid pneumatization in children with Down’s syndrome than in the control group. The children with OME showed poor development of mastoid pneumatization in the control group as well as in the Down’s syndrome group. However, the pneumatized mastoid developed with age in the control group, but hardly developed in the children with Down’s syndrome. From these results, we concluded that early diagnosis of OME and appropriate treatments are needed for children with Down’s syndrome. Furthermore temporal bone CT image seems to be one of the best ways to predict the clinical course of OME and to decide on optimum approach to therapy in children with Down’s syndrome.
14. Immunological
Noboru
mechanism of recurrent
acute otitis
media
Yamanaka
Department of Otolaryngology, Wakayama Medical College
Abstracts
291
Some children are subject to recurrent episodes of otitis media. At least 45% of children have three or more episodes by 3 years of age and up to 16% experience six or more episodes. Three bacterial species - Streptococcus pneurnoniae (SP), nontypable Haemophilus inflzlenzae (NTHI), Moraxella catarrhalis (MC) - account for the majority of identifiable bacterial causes of acute otitis media (AOM). Nontypable H. injluenzae is an increasingly frequent cause of otitis media in children. Infection with nontypable H. injbenzae is associated with strain specific immunity. Protective antibodies are directed against several outer membrane proteins. One specific protein, P6, is highly conserved between strains and antigenitally stable and has been proposed as a possible candidate for vaccine formulation. In the study of the systemic immune response to P6 of nontypable H. influenzae, otitis-prone children did not exhibit the same age-related rise in anti-P6 antibody as seen in nonotitis prone children and that otitis-prone children may not recognize P6 protein as a major immunogen in otitis media due to nontypable H. infuenzae. In the study of local immune response to NTHI, local antibody to the P6 protein in the outer membrane of nontypable H. injluenzae was detected in middle ear fluids of 94% of children with otitis media. IgG was the immunoglobulin class of specific antibody observed in highest concentrations. The strong correlation between serum antibody and middle ear antibody suggested that the antibody in middle ear fluid probably represented leakage of serum antibody into the middle ear space across an inflamed middle ear mucosa. Thus, during the early phase of otitis media with nontypable H. influenzae, a child manifests a systemic immune response, comprised in part of antibody to P6, and the antibody passes into the middle ear to kill the bacteria. Secretory IgA specific for P6 locally produced in the middle ear was of much smaller amount compared to IgG. It seemed, however, to be important in the protection of bacterial growth in the middle ear, since the positive rate and the concentration of P6 specific secretory IgA were both significantly higher in children without nontypable H. injluenzae.