Buchman Craig A, Doyle William J, Pilcher Oltavio, Gentile Deborah A, Skoner David P
Department of Otolaryngology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Am J Otolaryngol. 2002 Mar-Apr;23(2):70-5. doi: 10.1053/ajot.2002.30634.
Upper respiratory tract viral infections continue to cause substantial patient morbidity and complications including sinusitis, otitis media, and pneumonia. This study was conducted to more clearly define the extent and frequency of nasal and otologic effects of respiratory syncytial virus infection in healthy adult volunteers.
Thirty-two healthy, susceptible adult volunteers were cloistered for a 9-day period. During this time, subjects underwent nasal inoculation with respiratory syncytial virus. Monitoring included daily self-assessment of general health, as well as nasal and otologic symptoms. Objective measurements of nasal and otologic function included expelled nasal secretion weight, saccharin-dye mucociliary clearance, sonotubometry, tympanometry, and physical examination. A nasal lavage was done each morning, and fluids were submitted for viral detection. Twenty-one days after viral inoculation, all subjects had convalescent blood samples drawn for assay of virus-specific antibody titres.
Eighteen subjects (56%) became infected with the challenge as determined by either viral shedding (47%) or antigen detection (41%) from the nose or a 4-fold rise in virus-specific antibody titer (34%). Infected subjects more frequently reported adverse nasal (congestion, rhinorrhea) and general symptoms (fever, malaise, illness). By day 6, only 46% of infected subjects had normal middle ear pressure (> -100 mm H2O). Nasal secretion also increased substantially after infection. No patterned changes in mucociliary clearance or sonotubometry occurred, and no subjects developed otitis media.
Nasal inoculation of healthy, susceptible adult volunteers with respiratory syncytial virus results in detectable infection in only about half of the subjects challenged. Infected subjects experience substantial symptoms and signs of a viral upper respiratory tract illness. As in our previous studies using rhinovirus and influenza A virus, respiratory syncytial virus disrupted the maintenance of normal middle ear pressures. These findings provide further support for the relationship between viral upper respiratory tract infections and otitis media.
上呼吸道病毒感染持续导致患者出现严重发病情况及并发症，包括鼻窦炎、中耳炎和肺炎。本研究旨在更清晰地界定呼吸道合胞病毒感染对健康成年志愿者鼻腔和耳部影响的程度及频率。
32名健康、易感染的成年志愿者被隔离9天。在此期间，受试者经鼻腔接种呼吸道合胞病毒。监测内容包括每日对总体健康状况以及鼻腔和耳部症状的自我评估。鼻腔和耳部功能的客观测量包括排出的鼻分泌物重量、糖精 - 染料黏液纤毛清除率、声导抗测听、鼓室图检查及体格检查。每天早晨进行鼻腔灌洗，并将液体送检以检测病毒。病毒接种21天后，采集所有受试者的恢复期血样以检测病毒特异性抗体滴度。
通过鼻腔病毒脱落检测（47%）、抗原检测（41%）或病毒特异性抗体滴度升高4倍（34%）确定，18名受试者（56%）受到攻击病毒感染。受感染的受试者更频繁地报告有不良鼻腔症状（鼻塞、流涕）和总体症状（发热、不适、患病）。到第6天，只有46%的受感染受试者中耳压力正常（>-100 mm H2O）。感染后鼻分泌物也大幅增加。黏液纤毛清除率和声导抗测听未出现特定模式变化，且无受试者发生中耳炎。
对健康、易感染的成年志愿者经鼻腔接种呼吸道合胞病毒，仅约一半受攻击受试者出现可检测到的感染。受感染的受试者出现病毒性上呼吸道疾病的大量症状和体征。如同我们之前使用鼻病毒和甲型流感病毒的研究一样，呼吸道合胞病毒破坏了正常中耳压力的维持。这些发现为病毒性上呼吸道感染与中耳炎之间的关系提供了进一步支持。
