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- 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 with or without cholesteatoma
- System(s) affected: nervous, ENT
- Synonym(s): secretory or serous otitis media
- Predominant age: 6 to 24 months; declines >7 years; rare in adults
- Predominant gender: male > female
- By age 7 years, 93% of children have had ≥1 episodes of AOM; 39% have had ≥6.
- Placement of tympanostomy tubes is second only to circumcision as the most frequent surgical procedure in infants.
- Increased incidence in the fall and winter
- By age 4 years, 90% of children have had at least one episode.
- Most common infection for which antibacterial agents are prescribed in the United States
- Diagnosed 5 million times per year in the United States
Etiology and Pathophysiology
- AOM-b (bacterial): Usually, a preceding viral upper respiratory infection (URI) produces eustachian tube dysfunction.
- Streptococcus pneumoniae: 20–35%, Haemophilus influenzae: 20–30%, Moraxella (B.) catarrhalis: 15%, group A streptococci: 3%, Staphylococcus aureus: 12% produce β-lactamases that hydrolyze amoxicillin and some cephalosporins.
- AOM-v (viral): 15–44% of AOM infections are caused primarily by viruses (e.g., respiratory syncytial virus, parainfluenza, influenza, enteroviruses, adenovirus, human metapneumovirus, and parechovirus).
- AOM-s (sterile/nonpathogens): 25–30%
- OME: eustachian tube dysfunction; allergic causes are rarely substantiated.
- Strong genetic component in twin studies for recurrent and prolonged AOM
- May be influenced by skull configuration or immunologic defects
- Bottlefeeding while supine
- Routine daycare attendance
- Frequent pacifier use after 6 months of age
- Environmental smoke exposure
- Male gender
- Absence of breastfeeding
- Low socioeconomic status
- Family history of recurrent otitis
- AOM before age 1 year is a risk for recurrent AOM.
- Presence of siblings in the household
- Underlying ENT disease (e.g., cleft palate, Down syndrome, allergic rhinitis)
- Pneumococcal vaccine (PCV)-7 immunization reduces the number of cases of AOM by about 6–28% (however, evidence shows that this is offset by an increase in AOM caused by other bacteria). The effect of the introduction of the PCV-13 vaccine on the incidence of AOM has yet to be studied.
- Influenza vaccine reduces AOM.
- Breastfeeding for ≥6 months is protective.
- 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.
- Vitamin D supplementation (1,000 IU/day to maintain vitamin D levels >30) may be helpful in reducing recurrent AOM, but further trials are needed.
Commonly Associated Conditions