Cutting the Gordian knot: Unravelling demographic and pathophysiological factors influencing pathogen-specific immune responses in chronic otitis media-prone children

In Greek mythology, it is said that the impossibly tangled knot tied by Gordius, king of Phrygia, could only be unravelled by the future ruler of Asia; Alexander the Great solved this problem by cutting the knot with his sword. The phrase ‘cutting the Gordian knot’ is used today as a metaphor for a complex, seemingly intractable, problem to which a solution may be found only through taking decisive and bold steps [1]. This ancient legend comes to mind when considering the overlapping and interacting risk factors in the development of otitis media (OM) [2]. A greater understanding of these causal determinants will lead to targeted management strategies, more effective therapies and thus to improved patient outcomes for this global childhood illness. Foremost among topics where there is a knowledge gap are the colonization of the nasopharynx by pathogenic viruses or bacteria and the nature of the immune response that this triggers [3].