Presence of viral nucleic acids in the middle ear: Acute otitis media pathogen or bystander?

Tasnee Chonmaitree, Aino Ruohola, J. Owen Hendley

    Research output: Contribution to journalReview article

    19 Scopus citations


    Viruses play an important role in acute otitis media (AOM) pathogenesis, and live viruses may cause AOM in the absence of pathogenic bacteria. Detection of AOM pathogens generally relies on bacterial culture of middle ear fluid. When viral culture is used and live viruses are detected in the middle ear fluid of children with AOM, the viruses are generally accepted as AOM pathogens. Because viral culture is not sensitive and does not detect the comprehensive spectrum of respiratory viruses, polymerase chain reaction assays are commonly used to detect viral nucleic acids in the middle ear fluid. Although polymerase chain reaction assays have greatly increased the viral detection rate, new questions arise on the significance of viral nucleic acids detected in the middle ear because nucleic acids of multiple viruses are detected simultaneously, and nucleic acids of specific viruses are detected repeatedly and in a high proportion of asymptomatic children. This article first reviews the role of live viruses in AOM and presents the point-counterpoint arguments on whether viral nucleic acids in the middle ear represent an AOM pathogen or a bystander status. Although there is evidence to support both directions, helpful information for interpretation of the data and future research direction is outlined.

    Original languageEnglish (US)
    Pages (from-to)325-330
    Number of pages6
    JournalPediatric Infectious Disease Journal
    Issue number4
    StatePublished - Apr 2012


    • acute otitis media
    • middle ear fluid
    • viral PCR
    • viral upper respiratory tract infection

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health
    • Microbiology (medical)
    • Infectious Diseases

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