SYSTEMIC AND LOCAL IMMUNE REACTIVITY IN CHRONIC SUPPURATIVE OTITIS MEDIA


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Abstract

Introduction. The course of infectious inflammation in chronic suppurative otitis media and the outcome of surgical treatment depend on the reactivity of systemic and local immunity. Studying changes in the immune system in chronic suppurative otitis media will allow for the substantiation of recommendations for immunotropic therapy that simultaneously stimulates regeneration of the tympanic mucosa in the postoperative period.

Objective: To evaluate the pathogenetic significance of changes in the reactivity of systemic and local immunity in chronic suppurative otitis media.

Materials and Methods. The study included 49 patients with chronic suppurative otitis media, including 27 patients with mesotympanitis and 22 patients with epitympanitis. The control group included 15 patients. All patients underwent tympanoplasty using the overlay and underlay techniques. Intraoperatively, fragments of the tympanic mucosa were collected from most patients for pathological examination. The state of systemic cellular immunity was assessed using CD markers using flow cytometry. Humoral immunity parameters studied using the ELISA method included the quantitative determination of IgG, sIgA, IgA, IgM, C3, and C4 in serum.

Results and discussion. The changes in systemic immunity and cytokine status in chronic otitis media (COM) presented in this study indicate the active pathogenetic involvement of the immune system in the inflammatory process in the middle ear cavity. Changes were observed in cellular immunity (CD3/4+, CD16/56+, and CD19+ lymphocyte levels); humoral immunity (sIgA, CIC, and CRP levels); and cytokine status (IL-1β, TNF-α, and IFN-γ). The immunological indices CD4/CD8, CD8/NK, and IFN-γ/IL-10 proved to be highly informative. Pathological studies indicate that the predominance of lymphocytes in the cellular inflammatory infiltrate and the formation of foci of lymphocyte-plasmacytic infiltration, as well as the presence of neutrophils, eosinophils, and mast cells in the infiltrate, reflect the degree of inflammatory activity in chronic suppurative otitis media (mucositis) and the involvement of local immune cells in the inflammatory process.

Conclusion: Changes in the structural and functional organization of the middle ear mucosa are associated with changes in the reactivity of both local and systemic immunity, the state of which largely determines the outcome of the inflammatory process and surgical treatment of chronic suppurative otitis media.

About the authors

Ziyavdin M. Saidov

Author for correspondence.
Email: ziavdin333@mail.ru
ORCID iD: 0009-0006-6166-0872

Andrei S. Simbirtsev

State Research Institute of Highly Pure Biopreparations

Email: simbas@mail.ru
ORCID iD: 0000-0002-8228-4240
SPIN-code: 2064-7584

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

Russian Federation, Saint Petersburg

Yunuskadi A. Dzhamaludinov

Email: unys@yandex.ru
ORCID iD: 0000-0002-7099-3496

Alexander V. Krivtsov

Email: krivtzov@mai.ru
ORCID iD: 0000-0001-7986-0326

Marat Marat Z. Saidov

Email: marat.saidov.55@mail.ru
ORCID iD: 0000-0001-6246-4482

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