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Editorial commentary: Respiratory viruses and otitis media in young children.

Otitis media (OM) remains a major health problem for children throughout the world. In addition to the short-term morbidity and costs of the illness, children with persistent middle ear effusion may be at risk for long-term detrimental effects on speech and language. The annual cost of the medical and surgical treatment of OM in the United States alone is estimated at between $3 and $4 billion dollars. The pathogenesis of the disease is multifactorial. Infection by bacteria and viruses, abnormal function of the Eustachian tube, and relative immaturity of a child’s immune system are all known to be important in the development of acute otitis media (AOM) in young children. Upper respiratory tract infections (URTIs) with a number of viruses have long been associated with the development of OM. Early studies using relatively insensitive detection techniques such as viral culture and viral-specific antibody responses demonstrated clear associations between URTI with respiratory syncytial virus, influenza (type A or B), and adenovirus and the development of OM [1]. Weaker, but still significant associations were seen with infections caused by parainfluenza virus, enterovirus, and rhinovirus. Evidence that respiratory viruses themselves had a central pathogenic role was provided by later studies in which culture and antigen detection techniques demonstrated virus in the middle ear fluid itself of infected children [2]. Respiratory syncytial virus was the most frequently identified virus in middle ear fluid specimens, followed by parainfluenza and influenza. These early studies were hampered by the fact that even with the rigorous methods used, viral etiologies could be established for only about 40% of the children with OM associated with URTIs. The field has changed dramatically over the last 10 years with the development of polymerase chain reaction (PCR)–based methods for the detection of common respiratory viruses [3–5]. Viruses such as rhinovirus, human coronaviruses, human bocavirus, and human metapneumovirus, viruses whose presence had been difficult if not impossible to demonstrate using older methods, were now readily detected if present in respiratory secretion samples from individuals with URTIs [6, 7]. Clinical studies using the PCR-based techniques in children with URTIs routinely demonstrated the presence of 1 or more viruses in ≥75% of subjects. The same viruses documented in earlier work as being associated with AOM were confirmed as such in these later studies, but infection with additional viruses including rhinovirus and bocavirus were also found to have strong associations with the development of OM. These more recent studies also demonstrated that a significant percentage of asymptomatic children harbored viruses in their respiratory tracts when samples were examined by PCR [3, 6, 7]. It is against this backdrop that the study by Chonmaitree and coworkers in this issue of Clinical Infectious Diseases was undertaken. This is one in a series of papers from this Galveston-based group based upon their studies of young children with viral URTIs and AOM in an outpatient setting [4, 8, 9]. In the current work, the investigators defined the contribution of respiratory viruses to symptomatic disease and asymptomatic infection in infants <1 year of age, a population that has not yet been systematically investigated with respect to viral respiratory infections and OM. A large cohort of children from birth to 1 year of age were examined monthly with Received 22 August 2014; accepted 29 August 2014; electronically published 9 September 2014. Correspondence: Stephen J. Barenkamp, MD, Saint Louis University School of Medicine, Doisy Research Center, Rm 303, 1100 S Grand Blvd, Saint Louis, Missouri 63104 (barenksj@ slu.edu). Clinical Infectious Diseases 2015;60(1):10–11 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com. DOI: 10.1093/cid/ciu716