Otitis Media
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Basics
Description
- Inflammation of the middle ear; usually accompanied by fluid collection
- Acute otitis media (AOM): inflammation of the middle ear. Rapid onset; cause may be infectious, either viral (AOM-v) or bacterial (AOM-b), but there is also a sterile etiology (AOM-s).
- Recurrent AOM: ≥3 episodes in 6 months or ≥4 episodes in 1 year with ≥1 in the past 6 months
- Otitis media with effusion (OME): fluid in the middle ear without signs or symptoms of infection
- Chronic otitis media (COM): recurrent or chronic ear infections; with or without cholesteatoma
- System(s) affected: nervous
- Synonym(s): secretory or serous otitis media, glue ear
Epidemiology
Incidence- AOM
- Predominant age: 6 to 24 months; declines >7 years; rare in adults
- Predominant gender: male > female
- >80% of children have had at least 1 episode of AOM by age 3; 24% have had 3 or more episodes.
- Placement of tympanostomy tubes is second only to circumcision as the most frequent surgical procedure in infants.
- Increased incidence in the fall and winter
- OME
- 90% of children have had at least one episode by age 4.
Prevalence
- Most common infection for which antibacterial agents are prescribed in the United States
- >5 million cases diagnosed per year in the United States
Etiology and Pathophysiology
- AOM-b (bacterial): Usually, a preceding viral upper respiratory infection (URI) can produce eustachian tube dysfunction, leading to reduced clearance.
- Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis are most frequent pathogens. Streptococcus pyogenes, Mycoplasma spp are less frequent.
- AOM-v (viral): 15–44% of AOM infections are caused primarily by viruses (e.g., rhinovirus, respiratory syncytial virus, parainfluenza, influenza, enteroviruses, adenovirus, human metapneumovirus, and bocavirus).
- AOM-s (sterile/nonpathogens): 25–30%
- OME: middle ear inflammation and eustachian tube dysfunction; allergic causes are rarely substantiated.
Genetics
- Strong genetic component in twin studies for recurrent and prolonged AOM
- Immunologic defects and genetic disorders (e.g., Down syndrome) can predispose changes in physical anatomy (e.g., more horizontal and ear canals) that increase likelihood in developing otitis media.
Risk Factors
- Age—developing AOM prior to 1 year of age is a risk for recurrent AOM.
- Male gender
- Bottlefeeding while supine
- Routine daycare attendance
- Family history of AOM
- Frequent pacifier use after 6 months of age
- Environmental smoke exposure
- Absence of breastfeeding
- Low socioeconomic status
- Atopy
- Underlying ear/nose/throat (ENT) disease (e.g., cleft palate, allergic rhinitis)
General Prevention
- Pneumococcal vaccine (PCV)-7 immunization reduces the number of cases of AOM by about 29% (1)[B] (however, evidence shows that this is offset by an increase in AOM caused by other bacteria).
- Influenza vaccine (2)[B]
- Breastfeeding for ≥6 months is protective (2)[B].
- Avoiding supine bottlefeeding, passive smoke, and pacifiers >6 months may be helpful.
- Secondary prevention: Adenoidectomy and adenotonsillectomy for recurrent AOM have limited short-term efficacy and are associated with their own adverse risks.
Commonly Associated Conditions
URI
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Basics
Description
- Inflammation of the middle ear; usually accompanied by fluid collection
- Acute otitis media (AOM): inflammation of the middle ear. Rapid onset; cause may be infectious, either viral (AOM-v) or bacterial (AOM-b), but there is also a sterile etiology (AOM-s).
- Recurrent AOM: ≥3 episodes in 6 months or ≥4 episodes in 1 year with ≥1 in the past 6 months
- Otitis media with effusion (OME): fluid in the middle ear without signs or symptoms of infection
- Chronic otitis media (COM): recurrent or chronic ear infections; with or without cholesteatoma
- System(s) affected: nervous
- Synonym(s): secretory or serous otitis media, glue ear
Epidemiology
Incidence- AOM
- Predominant age: 6 to 24 months; declines >7 years; rare in adults
- Predominant gender: male > female
- >80% of children have had at least 1 episode of AOM by age 3; 24% have had 3 or more episodes.
- Placement of tympanostomy tubes is second only to circumcision as the most frequent surgical procedure in infants.
- Increased incidence in the fall and winter
- OME
- 90% of children have had at least one episode by age 4.
Prevalence
- Most common infection for which antibacterial agents are prescribed in the United States
- >5 million cases diagnosed per year in the United States
Etiology and Pathophysiology
- AOM-b (bacterial): Usually, a preceding viral upper respiratory infection (URI) can produce eustachian tube dysfunction, leading to reduced clearance.
- Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis are most frequent pathogens. Streptococcus pyogenes, Mycoplasma spp are less frequent.
- AOM-v (viral): 15–44% of AOM infections are caused primarily by viruses (e.g., rhinovirus, respiratory syncytial virus, parainfluenza, influenza, enteroviruses, adenovirus, human metapneumovirus, and bocavirus).
- AOM-s (sterile/nonpathogens): 25–30%
- OME: middle ear inflammation and eustachian tube dysfunction; allergic causes are rarely substantiated.
Genetics
- Strong genetic component in twin studies for recurrent and prolonged AOM
- Immunologic defects and genetic disorders (e.g., Down syndrome) can predispose changes in physical anatomy (e.g., more horizontal and ear canals) that increase likelihood in developing otitis media.
Risk Factors
- Age—developing AOM prior to 1 year of age is a risk for recurrent AOM.
- Male gender
- Bottlefeeding while supine
- Routine daycare attendance
- Family history of AOM
- Frequent pacifier use after 6 months of age
- Environmental smoke exposure
- Absence of breastfeeding
- Low socioeconomic status
- Atopy
- Underlying ear/nose/throat (ENT) disease (e.g., cleft palate, allergic rhinitis)
General Prevention
- Pneumococcal vaccine (PCV)-7 immunization reduces the number of cases of AOM by about 29% (1)[B] (however, evidence shows that this is offset by an increase in AOM caused by other bacteria).
- Influenza vaccine (2)[B]
- Breastfeeding for ≥6 months is protective (2)[B].
- Avoiding supine bottlefeeding, passive smoke, and pacifiers >6 months may be helpful.
- Secondary prevention: Adenoidectomy and adenotonsillectomy for recurrent AOM have limited short-term efficacy and are associated with their own adverse risks.
Commonly Associated Conditions
URI
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