Allergy and middle ear inflammation in children
Based on signs and symptoms,otitismedia (OM) can be subclassified into
different phenotypes:acute otitis media (AOM), otitis media with
effusion (OME), chronic OME (cOME) and chronic suppurative otitis media
(CSOM). AOM is generally characterized by rapid onset of signs and
symptoms of inflammation in the middle ear accompanied by middle ear
effusion (MEE); OME is defined as MEE without signs and symptoms of
acute inflammation. AOM episodes are self-limited, but some children are
at high risk for frequently recurring AOM episodes (RAOM) and in a
sub-group of patients, MEE may be delayed for months to years and may
evolve in cOME.11,12Eventually, CSOM may occur with or
without cholesteatoma and clinical history of both conditions can be
very similar in children.
There are many predisposing factors for otitis in children, including
genetic predisposition, young age, male gender, very low birth-weight,
pre-term birth, immature function of the immune system, little or no
breastfeeding, upper airway-infections, day-care attendance, older
siblings, tobacco smoke exposure, adenoid hypertrophy, craniofacial
abnormalities, dysfunction of the ET,use of a pacifier or push-and-pull
plastic bottle caps, and allergy.13 Among risk
factors, the role of allergy has been thoroughly investigated and has
been clearly implicated in pathogenesis of OME, whereasmore
controversial findingsare available for AOM.