Abstract
The status of infectious diseases in otorhinolaryngology has changed in recent years. Acute otitis media is a common infectious disease among children. Recently, clinical features of the illness have changed by several factors including an increase of antimicrobial-resistant pathogens, altered life style, and derangement of immune responses of the host. Penicillin-resistant Streptococcus pneumoniae were identified in about 30% of nasopharyngeal cultures from children with AOM. The isolated strains also had ermAM and mefE genes that were associated with resistance to macrolides. A study of the changes of S pneumoniae in the nasopharynx by pulsed-field gel electrophoresis (PFGE) showed that the second episode was caused by the reinf ection with a different strain rather than by persistence and reemergence of the first strain. Analysis of strains from siblings with AOM by PFGE also suggested that person-to-person transmission of the pathogen can occur among children. A study of the immune responses to S. pneumoniae in otitis-prone children showed that about 54% of the patients had subnormal levels of anti-pneumococcal capsular polysaccharidespecific IgG2.
These factors will be closely associated with the variation of the clinical features of AOM. We should pay much attention to the risks of selecting drug-resistant pathogens by empiric treatment. We should manage AOM with not only antibiotics but also otorhinolaryngological procedures like myringotomy, and washings of the nasopharynx and sinus to eliminate pathogens.
