Relationship between Nasopharyngeal Colonization and the Development of Otitis Media in Children

Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis are the predominant bacteria associated with otitis media. A cohort of 306 infants was followed from birth through 12 months to determine frequency and duration of colonization and risk of acute otitis media (AOM) and otitis media with effusion (OME). M. catarrhalis was the most common bacterium isolated. Infants colonized at£3 months of age were at increased risk of AOM and OME. Early colonization with M. catarrhalis revealed the greatest risk (relative risk [RR]A 1.24), especially for OME (RR A 1.57). There was a strong relationship between the frequency of colonization and OM (r A .37, P o .001,) for each pathogen. Although S. pneumoniae, nontypeable H. influenzae, and M. catarrhalis are part of the normal nasopharyngeal flora during infancy, an increased rate of colonization may identify a subpopulation of children that is at increased risk of OM. Otitis media (OM) is the most common disease diagnosed ryngeal cultures and ear examinations completed as part of scheduled visits; patterns of colonization with each of the major among children [1]. The incidence of OM is greatest in the first 2 years of life [1 ‐ 6]. Streptococcus pneumoniae, nontypeable middle ear pathogens were characterized. Haemophilus influenzae, and Moraxella catarrhalis are major pathogens in OM and cause C75% of the infections [7]. The Methods development of OM begins in the nasopharynx. While the nasopharynx is normally colonized with avirulent bacteria, such Study population. Eligible infants (n A 306) were consecuas viridans streptococci, nonhemolytic streptococci, diphthe- tively enrolled at two large group practices in the suburban Buffalo roids, and Neisseria species, potential middle ear pathogens area. Infants with craniofacial abnormalities, genetic disorders, and may also be carried asymptomatically. The rates of colonization immune deficiencies were excluded from the study. Information gathered at entry included history of recurrent otitis media, allerwith S. pneumoniae, nontypeable H. influenzae, and M. cagies, and smoking history of parents. In addition, information re