Otitis Media



  • 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) also known as suppurative otitis media, 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. This is also referred to as serous, secretory, or nonsuppurative otitis media.
  • Chronic suppurative otitis media (CSOM) also known as chronic otitis media: recurrent or chronic infection of the middle ear and mastoid cavity without an intact tympanic membrane; may present with or without cholesteatoma
  • System(s) affected: nervous



  • AOM
    • Predominant age: 6 to 24 months; declines >7 years; rare in adults
    • 50%–85% of children have had at least 1 episodes of AOM by age 3 years; 24% have had 3 or more episodes.
  • OME
    • 90% of children have had at least one episode by age 4 years

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, and Moraxella catarrhalis are the most frequent pathogens and account for 80% of AOM-b infections. Streptococcus pyogenes, Mycoplasma spp., Chlamydia, anaerobes, and other organisms 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.

Immunologic defects and genetic disorders (e.g., Down syndrome) can predispose changes in physical anatomy (e.g., more horizontal ear canals) that increase the likelihood of developing otitis media.

Risk Factors

  • Developing AOM prior to 1 year of age is a risk for recurrent AOM
  • Bottle feeding while supine; pacifier use
  • Routine daycare attendance
  • Family history of AOM
  • Environmental smoke exposure
  • Absence of breastfeeding during the first 6 months of life
  • Low socioeconomic status
  • Atopy (such as eczema, asthma)
  • Underlying ENT abnormalities (e.g., cleft palate)

General Prevention

  • PCV-7, PCV-13, and influenzae vaccines (1)[B]
  • Breastfeeding for ≥6 months is protective (1)[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


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