Prevalence of various respiratory viruses in the middle ear during acute otitis media

Background Vaccines against respiratory viruses may be able to reduce the f requency of acute otitis media. Although the role of respiratory viruses in the pathogenesis of acute otitis media is well established, the relative i mportance of various Viruses is unknown. Methods We determined the prevalence of various respiratory viruses in the middle-ear fluid in 456 children (age, two months to seven years) with acut e otitis media. At enrollment and after two to five days of antibiotic ther apy, specimens of middle-ear fluid and nasal-wash specimens were obtained f or viral and bacterial cultures and the detection of viral antigens. The vi ral cause of the infections was also assessed by serologic studies of serum samples obtained during the acute illness and convalescence. Results A specific viral cause of the respiratory tract infections was iden tified in 186 of the 456 children (41 percent). Respiratory syncytial virus was the most common virus identified in middle-ear fluid: it was detected in the middle-ear fluid of 48 of the 65 children (74 percent) infected by t his virus (P less than or equal to 0.04 for the comparison with any other v irus). Parainfluenza viruses (15 of 29 children [52 percent]) and influenza viruses (10 of 24 children [42 percent]) were detected in the middle-ear fl uid significantly more often than enteroviruses (3 of 27 children [11 perce nt]) or adenoviruses (1 of 23 children [4 percent]) (P less than or equal t o 0.01 for all comparisons). Conclusions Respiratory syncytial virus is the principal virus invading the middle ear during acute otitis media. An effective vaccine against upper r espiratory tract infections caused by respiratory syncytial virus may reduc e the incidence of acute otitis media in children, (N Engl J Med 1999;340:2 60-4.) (C) 1999, Massachusetts Medical Society.