Paranasal sinuses and middle ear infections : what do they have in common?

Otitis media and sinusitis are among the most common pediatric diseases and they share common features. Although the anatomy, physiology and disease processes are not identical, knowledge of the pathophysiology of middle ear disorders often provides to the pediatrician a useful understanding of sinus diseases. The same risk factors identified for otitis media may play a pivotal role in the development of sinusitis. Moreover, as both paranasal sinuses and middle ear acquire respiratory pathogens from nasopharynx, acute sinusitis is usually caused by the same bacterial pathogens that cause acute otitis media, with a major role for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, while anaerobes may predominate in chronic disease. A responsibility of bacterial biofilms in chronic sinusitis, similarly to otitis media, has been recently suggested. Biofilms, three-dimensional aggregates of bacteria, are refractory to antibiotics and thus might explain why some patients improve while on antibiotics but relapse after completion of therapy.