Is chronic OM a disease of microbial biofilm?

September 1, 2006
Michael G. Burke, MD

DR. BURKE, section editor for Journal Club, is chairman of the department of pediatrics at Saint Agnes Hospital, Baltimore. He is a contributing editor for <italic>Contemporary Pediatrics</italic>. He has nothing to disclose in regard to affiliations with

Investigators' analysis of biopsy specimens from the middle-ear mucosa of children with otitis media with effusion (OME) and recurrent OM upheld the so-called biofilm hypothesis: Namely, chronic OM is associated with the presence of biofilm (aggregated bacteria that usually adhere to a surface-in these cases, the middle-ear mucosa). The study was conducted in 26 children who were undergoing placement of a tympanostomy tube for treatment of OME and OM; controls were three children and five adults undergoing cochlear implantation.

Confocal laser scanning microscopic (CLSM) images were obtained from biopsy specimens of the middle-ear mucosa and were evaluated for biofilm morphology using generic stains and species-specific probes for Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Effusions, when present, were evaluated by polymerase chain reaction and culture for evidence of pathogen-specific nucleic acid sequences and bacterial growth.

Of the 26 children (mean age, 2.5 years) undergoing placement of a tympanostomy tube, 13 (50%) had OME, 20 (77%) had recurrent OM, and seven (27%) had both diagnoses. CLSM revealed biofilm on 46 (92%) of 50 middle-ear mucosa specimens from these children, including those that were not associated with effusion. Biofilm was not observed on any of the eight control middle-ear mucosa specimens (Hall-Stoodley L et al: JAMA 2006;296:202).