NASAL INFLAMMATION AND CHRONIC EAR DISEASE IN AUSTRALIAN ABORIGINAL CHILDREN

Objective: Chronic middle ear disease is common in Aboriginal children , and may be linked to nasal inflammation and Eustachian tube dysfunct ion. The pattern of nasal inflammation is unknown. The study reported here was performed to define the role of allergy and infection in caus ing nasal inflammation in Aboriginal children with chronic middle ear disease. Methodology: Thirty-one Aboriginal children aged between 3 an d 7 years underwent clinical assessment, audiometry and allergy skin t ests. Nasal swabs for bacterial culture and cytology were performed du ring the winter and again in spring to identify any seasonal variation . A randomized trial of nasal beclomethasone for 8 weeks was conducted in children with abnormal tympanometry to identify the effect of ther apy upon nasal cytology. Results: Twenty-six of the 31 children had ab normal tympanograms. Average hearing levels were reduced in nine child ren. Pathogenic organisms were isolated from most children: Streptococ cus pneumoniae (82%), Haemophilus influenzae (79%), Moraxella catarrha lis (39%) and Staphylococcus ar,reus (29%). Eight of the 31 children ( 26%) were atopic. Nasal cytology disclosed a marked neutrophil infiltr ate (80% of cells) during the winter, which fell significantly in spri ng to 52% of cells. Only two subjects had nasal eosinophilia of >10%. There was no effect of beclomethasone on nasal cytology. Conclusions: Chronic ear disease in Aboriginal children is associated with nasal in flammation, neutrophil infiltration and the presence of bacteria. Thes e features suggest respiratory infection as the main cause of chronic nasal inflammation in Aboriginal children with middle ear disease. The re is a seasonal variation in the severity of the nasal infiltrate, co nsistent with increased infections during winter. Despite a high preva lence of atopy, allergic nasal disease was uncommon.