Role of respiratory viruses in the etiopathogenesis of acute otitis media. How could be avoided?

Acute otitis media is one of the most common infection among children and although the treatment of it is directed towards the elimination of the bacteria from the middle ear space, viruses may also play an important etiologic role in this disease process [Mein, et al., 1979]. So, the aim of this study was to evaluate the prevalence of various respiratory viruses in middle ear effusion [MEE] and nasopharyngeal specimen in children with recurrent acute otitis media [AOM] who had failed to improve after antimicrobial therapy and to determine the incidence of respiratory syncytial virus [RSV] as one of the most common respiratory viruses in AOM. Middle ear effusion [MEE]samples collected at the time of tympanostomy tube placement from 54 children with recurrent AOM were subjected to reverse transecriptase polymerase chain reaction [RT-PCR] to detect the presence of RSV genomic sequences. Also MEE and nasopharyngeal specimens were subjected to viral and bacterial cultures to detect viral antigens. The viral cause of infections was also assessed by serologic studies of serum samples obtained during the acute illness and convalescence. Viral infection was detected in 43 out of 54 children [79.6%], RSV was isolated from 57.1% of patients by viral culture and antigen detection and from 81.5% by RT-PCR. So, we can conclude that viral infection particularly RSV either alone or concurrent with bacteria is present with large percentage of children with recurrent AOM than previously suspected and PCR has proved to be more sensitive and specific than viral cultures and immunoassays in the detection of viruses in specimen. This would be helpful in guiding the use of preventive measures such as RSV vaccine