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.