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2021-04-28

Photo of Marie Gisselsson-Solen
Senior physician Marie Gisselsson-Solén is part of a national research network that is studying in more detail why some ear infections result in more serious complications, while the vast majority heal by themselves. Photo: Olle Dahlbäck.

...Marie Gisselsson-Solén, researcher at the Department of Clinical Sciences (IKVL) and senior physician in ear, nose and throat diseases at Skåne University Hospital in Lund. Last autumn, four new research networks in Sweden each received financial support of more than SEK 500,000 from the Swedish Research Council (VR). This initiative aims to find new solutions and share methods that can reduce the development of antimicrobial resistance. You are the person behind one of these research networks. What does the network look like and what is your project about?

- We’ve received funding for a project that aims to find out what causes some ear infections to cause life-threatening complications, while the majority heal without treatment. Increased knowledge of this can help us be better at saying in which cases antibiotics should be used from the outset and in which cases it’s safe to wait and see. The network consists of ENT specialists and general practitioners from Lund, Stockholm and Umeå.

How big is the problem of antibiotic resistance in the field of ear, nose and throat diseases?

- Sweden is in a generally favourable situation in terms of antimicrobial resistance, but problems have still been on the increase in the 21st century. When it comes to the bacteria that cause infections in the ear, nose and throat field, it is perhaps above all Haemophilus influenzae that has become tougher to treat in recent years, as there are two types of resistance, both of which have increased. We also have some pneumococci with reduced susceptibility to beta-lactam antibiotics (penicillin and its relatives), but thankfully this isn’t a major problem in Sweden. But in many countries in Asia it has become absolutely impossible to treat pneumococcal infections with penicillin-like preparations, and this is of course a situation we want to avoid.

Do you have any theory as to why some patients develop severe and sometimes life-threatening complications from an ear infection, while the vast majority of ear infections heal by themselves without antibiotics?

- You can conclude that it has to do with the individual who is affected, with the bacterium that gives rise to the infection, or a combination of these two factors. In the former case, for example, one might imagine a poor immune system or an unfavourable anatomy, and in the latter quite simply extremely aggressive bacteria. I believe primarily in harmful bacteria, but we’ll see what we come up with.

How common are ear infections nationally, and what kinds of people are affected?

- Ear infection is the most common bacterial infection in children, and the most common cause of children being given antibiotics. It is most common of all in children under the age of two. Most have had at least one ear infection before they start school. Somewhere between 10 and 15 per cent of all children have recurring ear infections – they become known as “ear children”, i.e. children susceptible to ear infections. The infection is much rarer among older children and adults, although relatively speaking they have a greater propensity to suffer from harmful bacteria and complications.

How many patients suffer such severe complications from an ear infection that their lives can be in danger?

- We’re not really sure. It’s estimated that about 150 people a year suffer from some form of complication from an ear infection. Just under 100 of these have what is known as mastoiditis, a spread of the infection to the sinus behind the ear. Mastoiditis is not life-threatening in itself, but it can sometimes develop into a more serious complication, such as a blood clot in the veins that drain the brain, or an abscess inside the brain. One of the most dangerous complications is meningitis, but it’s not clear how common it is for an ear inflammation to be the gateway. This is because there is often a failure to look at the ears of these seriously ill patients when they arrive in hospital.

Are you running any other research projects?

- We actually have two studies under way – one retrospective and one forward-looking – in which we’re try to find out how common it is for meningitis to originate in the ear. Then, as soon as the pandemic allows, we’ll start a randomised study aimed at finding out how well tubes in the ears help to prevent recurrent ear infection. Although this is a procedure that is carried out very often, the evidence is poor, and both Cochrane and SBU, the Swedish Agency for Health Technology Assessment and Assessment of Social Services, have repeatedly stated that we need better studies in this area.

How has the pandemic affected your research projects?

- Our studies into meningitis had already begun and have continued during the pandemic, but we’ve consciously waited to start both the complication study and the study of tube treatment until the pandemic has quietened down.

What do you wish for most of all right now?

- As the mother of a teenager and a keen choral singer, I’d find it wonderful if life could return to a more normal situation, with young people being able to go to school and take part in activities, and us being able to start singing together again and going to concerts and the like, as well as starting our planned research studies!

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