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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
- 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 3 year, ~60% of children have had ≥1 episodes of AOM; 24% have had ≥3.
- 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
- >5 million cases diagnosed per year in the United States
Etiology and Pathophysiology
- AOM-b (bacterial): Usually, a preceding viral upper respiratory infection (URI) produces eustachian tube dysfunction, leading to reduced clearance.
- Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis are most frequent pathogens. Less frequent: Streptococcus pyogenes, Mycoplasma spp.
- 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.
- Strong genetic component in twin studies for recurrent and prolonged AOM
- May be influenced by skull configuration or immunologic defects
- Age—AOM before age 1 year 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
- Underlying ENT disease (e.g., cleft palate, allergic rhinitis)
- 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.
- 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