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Masja Straetemans, PhD; Niels van Heerbeek, MD, PhD; Elisabeth A. M. Sanders, MD, PhD; Joost A. M. Engel, MD, PhD; Anne G. M. Schilder, MD, PhD; Ger T. Rijkers, PhD; Kees Graamans, MD, PhD; Huub Straatman, MSc; Gerhard A. Zielhuis, PhD

Arch Otolaryngol Head Neck Surg. 2005;131:771-776.

Objective  To study the combined role of immune status and eustachian tube function in the development of recurrent bilateral otitis media with effusion (OME).

Design  Prospective cohort study.

Setting  Three academic and general hospitals.

Patients  Children aged 2 to 7 years with a first clinical episode of bilateral OME that persisted for at least 3 months; 136 (81%) of 168 eligible children participated. All children received bilateral tympanostomy tubes at study entry.

Main Outcome Measure  Recurrence of bilateral OME within 6 months after tube extrusion.

Results  Univariate analyses of various immunologic factors (IgA, IgG1, IgG2, IgG3, IgG4, mannose-binding lectin, and the FcRIIa-H/R131 genotype) and eustachian tube function (forced response test) did not show any significant associations with bilateral OME recurrence. Multivariate analyses showed that children with closing pressures higher than the 75th percentile and IgA or IgG2 levels below the 50th percentile of the cohort were more likely to develop recurrent OME than children with closing pressures higher than the 75th percentile and IgA or IgG2 levels above the 50th percentile. The corresponding risk ratios were 6.3 (95% confidence interval [CI], 1.0-40.1) for IgA level and 3.0 (95% CI, 1.1-8.2) for IgG2 level. The multivariate analyses also revealed that increasing serum levels of functional mannose-binding lectin were associated with decreasing probabilities of developing recurrent OME (odds ratio, 0.7; 95% CI, 0.6-1.0).

Conclusion  Recurrence of bilateral OME after tympanostomy tube placement is more likely in children with a combination of low IgA or low IgG2 levels with poor eustachian tube function and decreased levels of mannose-binding lectin.

Author Affiliations: Departments of Epidemiology and Biostatistics (Drs Straetemans and Zielhuis and Mr Straatman) and Otorhinolaryngology (Drs van Heerbeek and Graamans), Radboud University Nijmegen Medical Centre, and Department of Otorhinolaryngology, Canisius-Wilhelmina Hospital Nijmegen (Dr Engel), Nijmegen, the Netherlands; and Departments of Paediatric Immunology (Drs Sanders and Rijkers) and Otorhinolaryngology (Dr Schilder), University Medical Centre Utrecht, Wilhelmina Children’s Hospital Utrecht, Utrecht, the Netherlands.