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The proportions of secretory IgA (SIgA)-, IgG- and C3b-coated bacteria obtained from a well-defined area on the posterior wall of the nasopharynx (NPH) close to the Eustachian tube were determined. Samples taken from 25 otitis-prone (OP) and 25 non-otitis-prone (NOP) children with normal serum levels of IgA and IgG were evaluated using an immunofluorescence assay. Both groups harboured significantly more nasopharyngeal bacteria coated with IgG than with SIgA (p < 0.001). The OP children had significantly fewer SIgA-coated bacteria (p < 0.05) but more C3b-coated bacteria (p < 0.01) in the NPH than the NOP children had. No significant difference was noted between the two groups regarding IgG coating. The occurrence of Branhamella catarrhalis in the NHP was more pronounced in the OP group (p < 0.05). No significant differences in the occurrence of other middle ear pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus) or quantitative dominance of pathogens were noted between the two groups. Deficiency in SIgA coating of the nasopharyngeal bacteria may contribute to the otitis-prone condition.

Attachment of bacteria to nonciliated cells of the nasopharyngeal epithelium was evaluated by immunofluorescence assay in 25 otitis-prone and 25 non-otitis-prone children undergoing ear, nose, or throat surgery under general anesthesia. The bacterial findings were analyzed simultaneously, both qualitatively and quantitatively. In otitis-prone children, there was a significant preponderance of epithelial cells having greater than 50 attached bacteria (P less than .001) and of epithelial cells with attached Streptococcus pneumoniae and Haemophilus influenzae (P less than .05). Also, the occurrence of Branhamella catarrhalis in the nasopharynx was more pronounced in the otitis-prone group (P less than .05). No significant differences in the occurrence of other middle ear pathogens or quantitative dominance of pathogens were noted between the two groups. Abundant attachment of pathogens to the epithelial cells close to the nasopharyngeal orifice of the eustachian tube is of a significant factor for the development of the otitis-prone condition.

Epithelial cells were obtained by swabbing the posterior wall of the nasopharynx (NPH) of 15 patients (age one to 6 8/12 years; eight males, seven females) undergoing ENT-surgery under general anaesthesia for otitis media with effusion (OME). Individually matched, ear healthy children served as controls. Bacteria attached to the non-ciliated cells were calculated according to a method described. Furthermore, quantitative and qualitative bacteriological analyses were performed on samples obtained from mucoid middle ear effusion material as well as from the NPH. All patients and controls harboured middle ear pathogens (S. pneumoniae, H. influenzae, B. catarrhalis, or S. aureus) in the NPH. Only 33 per cent of the patients harboured middle ear pathogens in the middle ear effusion and the same pathogen was invariably found in the corresponding NPH. Attachment of bacteria to the non-ciliated cells of the NPH diminished significantly with growing age in the ear healthy control group but not in the OME group. OME is closely correlated to the presence of middle ear pathogens in the NPH and to attachment of bacteria to the epithelial cells in the NPH.

Otitis media develops when certain bacterial pathogens gain access to the middle ear cavity from the nasopharynx through the eustachian tube. Adhesion of bacteria, in particular Streptococcus pneumoniae and Haemophilus influenzae, to the non-ciliated epithelial cells of the nasopharynx, close to the opening of the eustachian tube, is significantly correlated to the otitis-prone condition in children. Otitis-prone children have significantly fewer bacteria in the nasopharynx coated with the immunoglobulin secretory IgA (SigA) then healthy children have. Adhesion and occurrence of middle ear pathogens in the nasopharynx decreases with advancing age. Epstein-Barr virus, causative agent of infectious mononucleosis, causes a remarkable increase in bacterial adhesion to epithelial cells.

Attachment of Streptococcus pneumoniae and Haemophilus influenzae to epithelial cells on the posterior wall of the nasopharynx (NPH) was determined in 10 healthy children, culture-positive for either of these microorganisms. By using immunofluorescence technique and specific fluorescein-labelled antisera against these microorganisms, it was shown that in only 2 of the children studied were these pathogens firmly attached to the non-ciliated cells of the NPH. Attachment of S. pneumoniae and H. influenzae to the epithelial cells close to the nasopharyngeal opening of the Eustachian tube is of the utmost importance for the development of invasive disease, especially acute otitis media. Attachment of these pathogens to the epithelial cells covering the adenoid tissue may naturally be of significance for the induction of specific antibody body production against these microorganisms.

Epithelial cells from the nasopharynx of 42 young healthy individuals were obtained by swabbing. The filtered cellular mixture was stained with acridine orange and bacteria attached to the epithelial cells were counted using a fluorescence microscope. Simultaneously qualitative and quantitative bacteriological analyses were performed. Young individuals (less than 2 years) had significantly more attached bacteria than older ones (11-15 years) (P = 0.0001). The presence of middle ear pathogens in the nasopharynx of young children was significantly more prominent than in the older age groups (P less than 0.001). Attachment of middle ear pathogens to nasopharyngeal epithelial cells of young individuals may predispose to otitis media.

Bacterial samples were obtained from the posterior wall of the nasopharynx (NPH) of 18 healthy children (age range 1 to 14 years, 10 males, 8 females) and subjected for immunofluorescence studies using fluorescein-labelled goat anti-human IgG and goat anti-human SIgA antibodies. Quantitative and qualitative bacteriological analyses were performed simultaneously. IgG-coated bacteria in the NPH were observed in 1-year-old subjects and opsonized bacteria seemed to increase in numbers and fluorescence intensity with increasing age. SIgA-coated bacteria appeared later, and intensely fluorescing bacteria were not seen until the age of 3 to 6 years. Thirteen out of the 18 children harboured middle ear pathogens in the NPH, but generally speaking non-pathogens dominated the bacterial flora. Immunoglobulins are of the utmost importance for the mucosal defence system, including protection against bacterial attachment to the epithelial cells (SIgA), and bacteriolysis and opsonization of the bacteria (IgG).

Epithelial cells were scraped from the posterior wall of the nasopharynx (NPH) of 20 consecutive patients (age range 1 to 52 years, 9 males, 11 females) undergoing ENT surgery under general anaesthesia. The cellular mixture was immediately homogenized, filtrated through a 5 microns pore filters and centrifuged (10 min, 1,500 rpm). Non-ciliated, squamous epithelial cells caught by the filter were harvested and stained with acridine orange. Epithelial cells with bacteria attached were evaluated when specimens were examined under a fluorescence microscope. A distinct difference was noted between young individuals and adult patients regarding bacterial adherence to nasopharyngeal epithelial cells, adherence in young patients being especially remarkable. Bacteria appeared not to attach to ciliated epithelial cells. The high incidence of otitis media infections among young individuals may be due to the remarkable bacterial adherence to nasopharyngeal non-ciliated epithelial cells in this age group.

Colonization of middle ear pathogens (S. pneumoniae, H. influenzae and B. catarrhalis), potential pathogens (S. aureus and coagulase-negative staphylococci) and non-pathogens was determined quantitatively on the posterior wall of the nasopharynx (NPH) of children (four age groups: under 2 years, 2-5 years, 6-10 years and 11-15 years). None of the 90 individuals examined was suffering at the time of bacterial sampling from acute otitis media (AOM), sinusitis, or tonsillitis. All individuals under 2 years of age harboured middle ear pathogens in the NPH, but only 40% of the individuals of the oldest age group (p less than 0.001). Furthermore, in the youngest group, 57% of the cases had pathogens in the NPH, which completely dominated the bacterial flora, i.e. constituted more than 90% of the total bacterial count when calculated as CFU/cm2. The corresponding count in the oldest age group was only 20% (p less than 0.01). One important reason for the high incidence of AOM among young children in particular seems to be the noticeable accumulation of middle ear pathogens in huge quantities in the NPH in this age group.

Quantification of middle ear pathogens (S. pneumoniae, H. influenzae and B. catarrhalis) and potential pathogens (S. aureus and coagulase-negative staphylococci) adhering to the posterior wall of the nasopharynx was performed in 20 patients of whom 5 were suffering from secretory otitis media (SOM), 5 from recurrent attacks of acute otitis media (rAOM), 5 from attacks of upper respiratory infection (URI) and 5 from blocked nose (BN). While the patients were under general anesthesia a glass cylinder (diameter 1.3 cm) was pressed against the posterior wall of the nasopharynx and swabs were taken from the mucosa delineated by the glass tube. Quantification of the bacteria was performed using blood and chocolate agar plates. Total bacterial counts ranged between 2.6 x 10(4)CFU/cm2 and 4.0 x 10(8)CFU/cm2. In the rAOM group, 4 out of 5 children had bacterial counts in the nasopharynx which constituted of 95% pathogens. Coagulase-negative staphylococci never exceeded 1.9 x 10(5)CFU/cm2.

Colonization of middle ear pathogens (S. pneumoniae, H. influenzae and B. catarrhalis) in the nasopharyngeal opening of the Eustachian tube (NO) was charted in 94 patients (170 ears) suffering from secretory otitis media (SOM). Subsequent determination of microorganisms in the middle ear effusion was performed. 76% of the patients had colonization of pathogens in the NO, while pathogens colonized the middle ear cavity (MEC) in 30% of the cases. Predominant pathogen was S. pneumoniae, followed by B. catarrhalis and H. influenzae. When colonizing the MEC, there was a 100% correlation to NO regarding B. catarrhalis, 81% correlation for S. pneumoniae and 57% for H. influenzae. S. aureus and/or coagulase-negative staphylococci were only occasionally found in the NO. Accumulation of a sticky glue effusion material in the middle ear cavity may serve as a barrier against ascending pathogens from the nasopharynx.

Streptococcus pneumoniae and Branhamella catarrhalis were obtained from the double-colonized nasopharynx of 3 healthy carriers and from the double-infected middle ear cavity of 3 patients suffering from acute otitis media. The bacterial strains were isolated and injected both separately and together into brain-heart infusion broth. Separately injected, both S. pneumoniae and B. catarrhalis survived in the broth for at least 48 h. When injected together, B. catarrhalis was completely suppressed after 16-24 h, whereas S. pneumoniae survived for at least 48 h. Thus S. pneumoniae had a remarkable inhibitory growth effect on B. catarrhalis, which can explain why double-infected middle ear cavities so seldom are found during acute otitis media.