Experimental studies of prevention and therapy in intractable otitis media

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Clinical signs and otoscopyThis increased level of inflammation was sustained for an additional 7days post-IN inoculation of NTHi, after which the mean tympanic membrane inflammation score increased to value of 2+ indicating moderate inflammation with an effusion present or suspected. This level of inflammation was maintained to day 14 after NTHi inoculation when the study was terminated.Quantitation of adherent NTHiThe mean number of NTHi adherent to floor mucus at the pharyngeal portion of the ET was significantly greater 4 days after IN inoculation than at one day post inoculation. Adherence to pharyngeal floor mucus continued to increase slightly over the remaining 10 days of observation. At the mid and tympanic portions of the ET, the number of NTHi adherent to floor mucus increased more gradually, not reaching a maximum value until day 14.NTHi adherence to roof mucus was significantly less than to floor mucus at all three portions of the ET on the days indicated. The number of NTHi adherent to cells of the mucosal epithelium in any portion (pharyngeal, mid, tympanic) or region (roof, floor) of the ET was negligible at all time points of this study.NTHi adherence to middle ear mucosa was minimal until approximately 7-10 days after inoculation when there were also clinical signs of the onset of OM as determined by both otoscopy and tympanometry and delineated above. This increase in mean adherent bacteria was significantly between days : 4 and 7 ; and 7 and 10 days.Electron microscopyNTHi were found embedded in the mucus in the ET lumen and were not observed below the depth of the ciliary tips nor were they seen adherent to the surface of any epithelial cell type in any compartment of the ET