The respiratory mucosal membrane that lines the middle-ear space and mastoid air cells is an immunologic defense consisting of constantly renewed mucus that contains lysozyme, a potent, bacteria-dissolving enzyme. In response to an invading organism, production of mucus is increased. Inflammatory dilation of vessels, white blood cell migration, and proteolytic enzyme and antibody deposition contribute to the formation of mucopurulent (containing both mucus and pus) secretions. All of the major classes of immunoglobulins have been identified in middle-ear effusions of patients with AOM. A significant type-specific antibody response in the serum to the bacteria responsible for AOM has been demonstrated. The presence of this type-specific antibody in middle-ear effusions is associated with clearance of mucopurulent secretions and an early return to normal middle-ear function.

The incidence of otitis media and attendant complications is higher in individuals with congenital or acquired immunologic deficiencies. The presence of a concomitant malignancy, the use of immunosuppressive drugs, uncontrolled diabetes, and previous irradiation are also associated with a higher risk of developing AOM and related complications.

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