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
• Otitis media with effusion (OME): Persistent middle ear fluid that is associated with AOM but can arise without prior AOM
• Chronic otitis media with or without cholesteatoma
• System(s) affected: Nervous; ENT
• Synonym(s): Secretory or serous otitis media

Epidemiology

• AOM:
  • Predominant age: 6–24 months; declines >7 years; rare in adults
  • Predominant sex: Male > Female
  • By age 7 years, 93% of children have had ≥1 episodes of AOM; 39% have had ≥6.
  • Placement of tympanostomy tubes is 2nd only to circumcision as the most frequent surgical procedure in infants.
  • Increased incidence in the fall and winter
• OME:
  • By age 4, 90% of children have had at least 1 episode

• Most common infection for which antibacterial agents are prescribed in the US
• Diagnosed 5 million times per year in the US

Risk Factors

• Premature birth
• Bottle-feeding while supine
• Routine daycare attendance
• Frequent pacifier use after 6 months of age
• Smoking in household; environmental smoke exposure
• Male gender
• Native American/Inuit ethnicity
• Low socioeconomic status
• Family history of recurrent otitis
• AOM before age 1 is a risk for recurrent AOM
• Presence of siblings in the household
• Underlying ear, nose, or throat (ENT) disease (e.g., cleft palate, Down syndrome, allergic rhinitis)

• Strong genetic component in twin studies for recurrent and prolonged AOM
• May be influenced by skull configuration or immunologic defects

General Prevention

• 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) (1)[C]. The effect of the introduction of the PCV-13 vaccine on the incidence of AOM has yet to be studied.
• Influenza vaccine reduces AOM by ~30% in children age >2 (by preventing influenza).
• Breast-feeding for ≥6 months is protective.
• Avoiding supine bottle-feeding, passive smoke, and pacifiers >6 months may be helpful.
• Secondary prevention: Adenoidectomy and adenotonsillectomy for recurrent AOM has limited short-term efficacy for children >3 years of age and is associated with its own adverse risks.

Etiology

• AOM-b (bacterial): Usually, a preceding viral 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.

Commonly Associated Conditions

URI