How do viruses and bacteria cause acute otitis media (AOM)?

Updated: Sep 25, 2019
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

To become pathogenic in hollow organs, such as the ear or sinus, most bacteria must adhere to the mucosal lining. Viral infections that attack and damage mucosal linings of respiratory tracts may facilitate the ability of the bacteria to become pathogenic in the nasopharynx, eustachian tube, and middle ear cleft.

This theory might explain why viral antigens are commonly recovered from middle ear aspirates in children with AOM but the actual virus is only rarely isolated. Data have also been presented indicating that mucosal damage by endotoxins secreted by bacterial invaders may similarly enhance the adhesion of pathogens to mucosal surfaces.

Viral infection in the nasopharynx with subsequent inflammation of the orifice and mucosa of the eustachian tube has long been understood as part of the pathogenesis of AOM, although the complete role of the virus is not fully understood. Concurrent or antecedent URTIs are identified in at least a quarter of all attacks of AOM in children, but the virus itself seldom appears as the pathogen in the middle ear. Administration of trivalent influenza A vaccine has been shown to reduce the frequency of AOM during the influenza season. [5]


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