Faculty of Medical Sciences, Institute of Biosciences, Newcastle Medical School, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, UK.
Department of Paediatric Otolaryngology, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
Expert Rev Mol Med. 2021 Aug 18;23:e10. doi: 10.1017/erm.2021.10.
Otitis media (OM) is a common reason for children to be prescribed antibiotics and undergo surgery but a thorough understanding of disease mechanisms is lacking. We evaluate the evidence of a dysregulated immune response in the pathogenesis of OM.
A comprehensive systematic review of the literature using search terms [otitis media OR glue ear OR AOM OR OME] OR [middle ear AND (infection OR inflammation)] which were run through Medline and Embase via Ovid, including both human and animal studies. In total, 82 955 studies underwent automated filtering followed by manual screening. One hundred studies were included in the review.
Most studies were based on in vitro or animal work. Abnormalities in pathogen detection pathways, such as Toll-like receptors, have confirmed roles in OM. The aetiology of OM, its chronic subgroups (chronic OM, persistent OM with effusion) and recurrent acute OM is complex; however, inflammatory signalling mechanisms are frequently implicated. Host epithelium likely plays a crucial role, but the characterisation of human middle ear tissue lags behind that of other anatomical subsites.
Translational research for OM presently falls far behind its clinical importance. This has likely hindered the development of new diagnostic and treatment modalities. Further work is urgently required; particularly to disentangle the respective immune pathologies in the clinically observed phenotypes and thereby work towards more personalised treatments.
中耳炎（OM）是儿童开具抗生素和接受手术的常见原因，但对疾病机制缺乏透彻的了解。我们评估了免疫反应失调在 OM 发病机制中的作用的证据。
使用搜索词[中耳炎 OR 胶耳 OR AOM OR OME]或[中耳 AND（感染 OR 炎症）]对文献进行全面的系统综述，这些搜索词通过 Ovid 在 Medline 和 Embase 中运行，包括人类和动物研究。共有 82955 项研究经过自动过滤，然后进行手动筛选。共有 100 项研究纳入了综述。
大多数研究基于体外或动物工作。病原体检测途径（如 Toll 样受体）的异常已证实与 OM 有关。OM 的病因、其慢性亚组（慢性 OM、持续性伴渗出液 OM）和复发性急性 OM 很复杂；然而，炎症信号机制经常被牵连。宿主上皮可能起着至关重要的作用，但人类中耳组织的特征落后于其他解剖部位。
目前，OM 的转化研究远远落后于其临床重要性。这可能阻碍了新的诊断和治疗方法的发展。迫切需要进一步的工作；特别是要理清临床上观察到的表型中的各自免疫病理学，从而朝着更个性化的治疗方向努力。
