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Otitis media (OM), inflammation of the middle ear, is a highly prevalent pediatric disease globally [1], [2]. Unlike many other infectious diseases, bacterial OM is not caused by classically virulent microorganisms, but rather by commensals of the pediatric nasopharynx (NP) that can nonetheless behave as opportunistic pathogens when conditions are optimal for them to do so. OM is a significant cause of morbidity and has many important sequelae, such as conductive hearing loss [3], [4] accompanied by delays in language, behavioral and cognitive development [2], [5]. In addition, the direct and indirect costs associated with OM are estimated to exceed $5 billion annually in the United States aloneOM is often associated with preceding or concurrent viral upper respiratory tract infection, such as those caused by parainfluenza virus [9], influenza virus [10], [11], [12], rhinovirus [13], adenovirus [14] and respiratory syncytial virus (RSV) [9], [13]. Infection by upper respiratory tract viruses results in dysregulation of normal Eustachian tube (ET) function via decreased mucociliary action, altered mucus secretion by goblet cells and increased expression of inflammatory mediators of the host [15], [16], [17], among other mechanisms. The resultant transient reduction in protective functions of the ET provides the opportunity for commensal bacteria of the NP to ascend into the middle ear and cause disease. The three most common bacterial causative agents of OM are Streptococcus pneumoniae, nontypeable Haemophilus influenzae (NTHI) and Moraxella catarrhalis, all of which are normal commensal species of the pediatric NP [18], [19], [20]. To better understand the pathogenesis of OM, animal models are utilized in the study of all three predominant pathogens of OM [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32]; however, the lack of a model wherein M. catarrhalis ascends into the middle ear has strongly hindered studies of M. catarrhalis-induced OM.
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