Immunopathogenesis of polymicrobial otitis media

J Leukoc Biol. 2010 Feb;87(2):213-22. doi: 10.1189/jlb.0709518. Epub 2009 Oct 20.


OM, or inflammation of the middle ear, is a highly prevalent infection in children worldwide. OM is a multifactorial disease with multiple risk factors, including preceding or concurrent viral URT infection. Hence, OM is also a polymicrobial disease. The mechanisms by which viruses predispose to bacterial OM are replete; however, all are predicated on the general principle of compromise of primary host airway defenses. Thus, despite an as-yet incomplete understanding of the molecular mechanisms involved in bacterial superinfection of a virus-compromised respiratory tract, the URT viruses are known to induce histopathology of airway mucosal epithelium, up-regulate expression of eukaryotic receptors used for bacterial adherence, alter the biochemical and rheological properties of airway mucus, and affect innate and acquired host immune functions, among others. Although discussed here in the context of OM, during preceding or concurrent viral infection of the human respiratory tract, viral impairment of airway defenses and the resulting predisposition to subsequent bacterial coinfection are also known to be operational in the mid and lower airway as well.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Bacterial Infections / immunology
  • Bacterial Infections / pathology
  • Bacterial Infections / physiopathology
  • Child
  • Child, Preschool
  • Humans
  • Otitis Media / immunology*
  • Otitis Media / pathology
  • Otitis Media / physiopathology*
  • Respiratory Mucosa / immunology
  • Respiratory Mucosa / microbiology
  • Respiratory Mucosa / physiopathology
  • Respiratory Mucosa / virology
  • Respiratory Tract Infections / immunology*
  • Respiratory Tract Infections / pathology
  • Respiratory Tract Infections / physiopathology*
  • Virus Diseases / immunology
  • Virus Diseases / pathology
  • Virus Diseases / physiopathology