- 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 otitis media (COM): recurrent or chronic ear infections; with or without cholesteatoma
- System(s) affected: nervous
- Predominant age: 6 to 24 months; declines >7 years; rare in adults
- Predominant gender: male > female
- 50%–85% 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
- 90% of children have had at least one episode by age 4.
- 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.
- 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.
- Age—developing AOM prior to 1 year of age is a risk for recurrent AOM
- Male gender
- Race and ethnicity
- Bottlefeeding while supine; pacifier use
- Routine daycare attendance
- Family history of AOM
- Environmental smoke exposure
- Absence of breastfeeding during first 6 months of life
- Low socioeconomic status
- Underlying ENT disease (e.g., cleft palate, allergic rhinitis)
- PCV-7 and PCV-13 vaccines have lead to a decrease incidence of streptococcal pneumonia induced otitis media (1).
- 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. Xylitol is effective at preventing AOM but requires dosing 5 times daily making it impractical as a common preventative treatment.
Commonly Associated Conditions
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Domino, Frank J., et al., editors. "Otitis Media." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688524/all/Otitis_Media.
Otitis Media. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688524/all/Otitis_Media. Accessed May 29, 2023.
Otitis Media. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688524/all/Otitis_Media
Otitis Media [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 29]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688524/all/Otitis_Media.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Otitis Media ID - 1688524 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688524/all/Otitis_Media PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -