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Objective. To evaluate the effect of uncomplicated viral respiratory infections (colds) on middle ear pressure in healthy school-aged children. Methods. Children (ages 2-12) with normal tympanograms before onset of illness had bilateral tympanometry daily except weekends for 2 weeks after the onset of a cold. Nasopharyngeal secretion obtained at onset of illness was cultured for bacterial pathogens of otitis media using selective agars and tested for rhinovirus, coronavirus, respiratory syncytial virus, influenza A and B, and parainfluenza 1-3 by reverse transcriptase polymerase chain reaction technology. Tympanometry was designated as abnormal with peak pressure of [less than or equal to] -100 daPa or [greater than or equal to] 50 daPa and/or a compliance peak of Results. Eighty-six colds were studied, 82 in schoolchildren (5-12 years old) and 4 in 2- to 3-year-olds. Abnormal negative middle ear pressure occurred at least once during the 2 weeks after onset in 57 (66%) of the 86 colds. Tympanometry was abnormal in the first week after onset in 50 (88%) of the 57 colds and was abnormal on a single day in 17 (30%) of the 57. The middle ear pressure abnormalities were intermittent and shifted from one ear to the other ear from day to day. Reverse transcriptase polymerase chain reaction was positive for a respiratory virus in 56 (65%) of the 86 illnesses. Rhinovirus was found in 48% and respiratory syncytial virus in 14%. Pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) were detected in nasopharyngeal secretion in 29 (34%) of the 86 colds; the bacteria were in high titer ([greater than or equal to] [10.sup.3] cfu/mL) in 26 of the 29 positive specimens. None developed illness that required a visit to a physician. Age, detection of a respiratory virus, and presence of bacterial pathogen in the nasopharyngeal secretion had a negligible effect on the occurrence of abnormal tympanometry. Occurrence of negative middle ear pressure in winter-spring colds was significantly greater than in fall colds for unexplained reasons. Conclusions. Transient negative middle ear pressure occurred in two thirds of uncomplicated colds in healthy children. This negative pressure, which may facilitate secondary viral or bacterial otitis media, seems to result from viral infection of the nasopharynx and distal tube causing bilateral eustachian tube dysfunction. Tympanometry provides an objective measure of the potential beneficial effects of investigational treatments on the risk of eustachian tube dysfunction/otitis media. Pediatrics 2002;109:826-832; otitis media, eustachian tube, viral respiratory infections, tympanometry., Otitis media is the most common diagnosis for which antibiotics are prescribed for children in the United States. This diagnosis has increased in frequency by 250% over a 15-year period [...]

Most common respiratory viruses are present in children with acute otitis media (AOM) and seem to actually be contributory to causing or increasing the risk of AOM. The viruses were found in 75% of 92 children between the ages of three months and seven years and included human rhinovirus (HRV), respiratory syncytial virus and coronavirus. HRV was the most common, found in 24% - 35% of the children with AOM. These tests reinforce, confirm and extend conclusions of earlier studies., Objective. To determine the frequencies of human rhinovirus (HRV), respiratory syncytial virus (RSV), and coronavirus (HCV) infection in children with acute otitis media (AOM). Methods. Middle ear fluids (MEF) collected by tympanocentesis and nasopharyngeal aspirates (NPA) at the time of the AOM diagnosis were examined by reverse transcriptase polymerase chain reaction for HRV, RSV, and HCV RNA. Patients. Ninety-two children aged 3 months to 7 years during a 1-year period. Results. Virus RNA was detected in a total of 69 children (75%) and in 44 MEF samples (48%) and 57 NPA samples (62%) at the time of AOM diagnosis. HRV RNA was detected in both MEF and NPA in 18 (20%), in MEF alone in 4 (4%), and in NPA alone in 10 (11%). RSV was detected in both MEF and NPA in 12 (13%), in MEF alone in 5 (5%), and in NPA alone in 9 (10%). HCV RNA was detected in both MEF and NPA in 5 (5%), in MEF alone in 2 (2%), and in NPA alone in 9 (10%). Dual viral infections were detected in 5% of children. HRV and RSV were detected simultaneously in 2 MEF samples and in 2 NPA samples; RSV and HCV were detected in I NPA sample. Bacterial pathogens were detected in 56 (62%) MEF from 91 children. Viral RNA was detected in 20 (57%) MEF of 35 bacteria-negative and in 25 (45%) of 56 bacteria-positive MEF samples. No important differences in the risk of treatment failure, relapse, or occurrence of late secretory otitis media were noted between children with virus-positive and virus-negative MEF aspirates. Conclusion. These findings highlight the importance of common respiratory viruses, particularly HRV and RSV, in predisposing to and causing AOM in young children. Pediatrics 1998;102:291-295; RT-PCR, acute otitis media, rhinovirus, respiratory syncytial virus, coronavirus., ABBREVIATIONS: AOM, acute otitis media; RSV, respiratory syncytial virus; HRV, human rhinovirus; RT-PCR, reverse transcriptase polymerase chain reaction; HCV human coronavirus; NPA, nasopharyngeal aspirates; MEF, middle ear fluids; PBS, phosphate-buffered [...]

Infants and children younger than two years of age who are routinely exposed to passive smoke are at greater risk for wheezing and viral infection. Researchers assessed the prevalence of viral infection, passive smoke exposure and immunoglobulin E (IgE) measurements in infants and children under two years. These children had a high rate of viral infection and a low rate of IgE antibody to inhalant allergens. When exposed to passive smoke, these children registered elevated levels of salivary cotinine that suggested considerable exposure. Beyond two years of age, sensitization to inhaled allergens became ever more important, and viruses continued to be a major risk factor. Odds ratios for wheezing were significant for virus and cotinine in children under the age of two. Young patients should have reduced tobacco smoke exposure at home and be sensitized to inhaled allergens and avoid allergens to prevent wheezing., Objective. To examine the prevalence of viral infection, passive smoke exposure, and IgE antibody to inhaled allergens in infants and children treated for acute wheezing. Design. Case-control study of actively wheezing children who were compared with children without respiratory tract symptoms. Setting. University of Virginia Pediatric Emergency Room. Patients. Convenience sample of 99 wheezing patients (2 months to 16 years of age) and 57 control patients (6 months to 16 years of age). Measurements and results. Serum IgE antibody to inhalant allergens, measured by radioallergosorbent test (RAST), was uncommon in wheezing and control patients under age 2. After 2 years of age, the percentage of Rast-positive patients increased markedly and was significantly higher in wheezing patients than controls after age 4 (72%, n = 54, and 30%, n = 40, respectively, P age, particularly after age 2 years.

Abstract. Thirty-eight pediatric outpatients with pneumonia were studied by counterimmunoelectrophoresis for the presence of Haemophilus influenzae type b or pneumococcal antigenuria. Of the 38 patients eight (21%) had H influenzae type b antigenuria and two (5%) had pneumococcal antigenuria. H influenzae type b antigenuria was detected more frequently in patients <2 years of age than in older children. Urine counterimmunoelectrophoresis appears to be a useful tool for the etiologic diagnosis of bacterial pneumonia and should facilitate further studies of the epidemiology, pathogenesis, and clinical spectrum of this disease. Pediatrics 1983;71:780-783; counterimmunoelectrophoresis, bacterial pneumonia. [ABSTRACT FROM AUTHOR]