Objective Otitis media (OM) is a common reason for children to be prescribed antibiotics and undergo surgery but a thorough understanding of disease mechanisms is lacking. We evaluate the evidence of a dysregulated immune response in the pathogenesis of OM. Methods A comprehensive systematic review of the literature using search terms [otitis media OR glue ear OR AOM OR OME] OR [middle ear AND (infection OR inflammation)] which were run through Medline and Embase via Ovid, including both human and animal studies. In total, 82 955 studies underwent automated filtering followed by manual screening. One hundred studies were included in the review. Results Most studies were based on in vitro or animal work. Abnormalities in pathogen detection pathways, such as Toll-like receptors, have confirmed roles in OM. The aetiology of OM, its chronic subgroups (chronic OM, persistent OM with effusion) and recurrent acute OM is complex; however, inflammatory signalling mechanisms are frequently implicated. Host epithelium likely plays a crucial role, but the characterisation of human middle ear tissue lags behind that of other anatomical subsites. Conclusions Translational research for OM presently falls far behind its clinical importance. This has likely hindered the development of new diagnostic and treatment modalities. Further work is urgently required; particularly to disentangle the respective immune pathologies in the clinically observed phenotypes and thereby work towards more personalised treatments.

中文翻译：

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中耳炎免疫反应失调

目的 中耳炎 (OM) 是儿童开具抗生素和接受手术的常见原因，但缺乏对疾病机制的透彻了解。我们评估了 OM 发病机制中免疫反应失调的证据。方法 使用检索词 [中耳炎或胶耳或 AOM 或 OME] 或 [中耳 AND（感染或炎症）] 对文献进行全面系统回顾，这些检索词通过 Medline 和 Embase 通过 Ovid 运行，包括人类和动物研究。总共有 82 955 项研究进行了自动筛选，然后进行了手动筛选。一百项研究被纳入审查。结果 大多数研究基于体外或动物研究。病原体检测途径的异常，例如 Toll 样受体，已证实在 OM 中的作用。OM的病因，其慢性亚组（慢性 OM、持续性 OM 伴积液）和复发性急性 OM 很复杂；然而，炎症信号机制经常受到牵连。宿主上皮细胞可能起着至关重要的作用，但人类中耳组织的表征落后于其他解剖亚位点。结论 OM 的转化研究目前远远落后于其临床重要性。这可能阻碍了新诊断和治疗方式的发展。迫切需要进一步的工作；特别是要解开临床观察到的表型中各自的免疫病理学，从而朝着更个性化的治疗方向努力。宿主上皮细胞可能起着至关重要的作用，但人类中耳组织的表征落后于其他解剖亚位点。结论 OM 的转化研究目前远远落后于其临床重要性。这可能阻碍了新诊断和治疗方式的发展。迫切需要进一步的工作；特别是要解开临床观察到的表型中各自的免疫病理学，从而朝着更个性化的治疗方向努力。宿主上皮细胞可能起着至关重要的作用，但人类中耳组织的表征落后于其他解剖亚位点。结论 OM 的转化研究目前远远落后于其临床重要性。这可能阻碍了新诊断和治疗方式的发展。迫切需要进一步的工作；特别是要解开临床观察到的表型中各自的免疫病理学，从而朝着更个性化的治疗方向努力。