Objective
To elucidate the role of cytokines, immunoglobulins, and bacterial pathogens in the middle ear effusions (MEEs) of children with otitis media (OM).
Design
Paired MEEs and serum samples collected from consecutive patients were assayed for immunoglobulins. Middle ear effusions were cultured for bacterial pathogens and assayed for interleukin-1β, interleukin-6, tumor necrosis factor a, and interferon y. The medical charts of the patients were retrospectively reviewed to define the history of OM.
Subjects
Seventy-five patients with a history of recurrent acute OM, persistent OM with effusion, or both. Exclusion criteria included the presence of a major coexisting condition, or an unclear or atypical history of OM.
Setting
A private practice at a tertiary care children's hospital.
Interventions
At the time of tympanostomy tube place-ment, with the patient under general anesthesia, one MEE and a serum sample were collected.
Results
Interleukin-1β was detected in 58% (44/75) MEEs; interleukin-6, 83% (60/72); tumor necrosis factor a, 38% (38/75); and interferon y, 61% (45/74). Concentrations of interleukin-1β, interleukin-6 and tumor necrosis factor 
in MEEs were highly correlated with each other (P<.01 for each association) suggesting increased local production and the expected effects of cytokines stimulating their own production during OM. High concentrations of tumor necrosis factor a in MEEs were also associated with a history of multiple placements of tympanostomy tubes (r=.63).
Conclusions
These data suggest a regulatory role for cytokines in inflammation during OM, and suggest that high concentrations of tumor necrosis factor a in MEEs may be a marker for OM chronicity.
(Arch Otolaryngol Head Neck Surg. 1995;121:865-869)
