The role of bacteria as a local defence mechanism in the ear, nose and throat.

The mucosae of the oro-nasopharynx in man are asymptomatically colonised by a commensal flora. This commensal flora consists largely of non-pathogenic bacteria but potentially pathogenic bacteria, such as S. pneumoniae, H. influenzae, M. catarrhalis can also be part of it. The commensal flora can be affected by host factors such as age or antibiotic usage but will in itself also affect its host. In addition to being a source of resistance genes it will also protect the host against exogenous, non-commensal pathogens. This protective effect is the result of three characteristics of the commensal flora. The commensal flora will hinder the establishment of new pathogens on the mucosa (termed colonisation resistance), it will especifically stimulate the immune system and it will induce formation of protective antibodies.