What is the role immunoglobulins in the pathogenesis of 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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Much attention has been focused on the immunoglobulins and the patient’s ability to form them. Immunoglobulin G2 (IgG2) and immunoglobulin G4 (IgG4) are responsible for immunity against polysaccharide antigens; deficiencies in the formation of these antibodies invariably lead to otitis media. Many patients with Down syndrome show decreased function of immunoglobulin A (IgA), IgG2, or IgG4, which partially explains their increased risk for chronic rhinitis and otitis media.

The immunologic aspects of AOM are not confined to the middle ear. The nasopharynx plays an important role in the pathogenesis of AOM, and immunologic modifications in this lymphoid tissue provide some protection from pathogens by preventing their adherence to mucosal surfaces. The presence of nasopharyngeal IgA antibodies to pneumolysin toxin released by pneumococcal autolysis appears to protect against invasion by healthy pneumococci.

On the other hand, not all immunoglobulins in the nasopharynx are protective. Bernstein describes the effects of immunoglobulin E (IgE) hypersensitivity or hyperimmune effects on the eustachian tube mucosa. [6] The allergic response in the nasopharyngeal end of the eustachian tube promotes stasis and the subsequent formation of a middle ear effusion.

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