Acute
otitis media is generally considered a simple
bacterial infection that can be effectively treated with
antibiotics. However, despite the extensive use of broad-spectrum
antibiotics, poor clinical response to treatment of acute
otitis media is common in children. Numerous studies ranging from animal experiments to extensive clinical studies have clearly demonstrated that respiratory viruses play a crucial role in the aetiology and pathogenesis of acute
otitis media.
Viral infection of the upper respiratory tract initiates the whole cascade of events that finally leads to the development of acute
otitis media as a complication. Respiratory viruses induce a release of inflammatory mediators in the nasopharynx, increase bacterial colonization and adherence, and have a suppressive effect on the host's immune defense. Recent data indicate that at least some types of viruses actively invade the middle ear. Viruses also seem to enhance the inflammatory process in the middle ear and impair the outcome of the disease.
Vaccines against the major viruses predisposing to acute
otitis media hold a great promise for the prevention of this disease. Major advances in the management of acute
otitis media will require further research into the mechanisms of
viral infection, viral-bacterial interaction and the host inflammatory response during
viral infection.