The presence of immunoglobulins in chronic OME was associated mainly with the bacterial infection. 128 Á 131 IgG and IgA antibodies specific to Hemophilus influenzae and S. pneumoniae , 128 IgG, IgM, IgA and secretory IgA antibodies specific to outer membrane antigens of Moraxella catarrhalis, 129 and Staphylococcus aureus -harboured bacteria, intensely coated with secretory IgA and IgG antibodies, 130, 131 were identified in chronic effusions. Only one type of immunoglobulins, the secretory IgA, was identified in effusions infected with respiratory viruses. 132 The presence of IgE in chronic OME has not been always associated with local allergic inflammation. 124, 133 However, local overproduction of IgE was usually accompanied by local allergic reactions, such as degranulation of mast cells found in the middle ear biopsy specimens 124 and expression of IgE on mast cells detected in nasal mucosa specimens from patients with OME. 134 Thus, the activity of immunoglobulins in chronic OME is evidence of chronic humoral inflammatory processes in the middle ear, which is obviously controlled by cytokines. Correlation between the levels and types of immunoglobulins and the immunoregulatory and allergy-associated cytokines in chronic OME has not been investigated. However, the presence of the main types of immunoglobulins, IgM, IgG, IgA, secretory IgA and IgE, in effusions is indirect evidence that cytokines IL-2, IL-10, TGF-b, IL-4 and IL-5, which are involved in regulation of immunoglobulin production and secretion in general, 2, 11, 12, 16, 25 participate also in local production and secretion of immunoglobulins and regulate humoral immune reactions during the course of middle ear inflammation (Figs 3 Á/6 ).