Otitis media in children

Overview

Acute otitis media (AOM) is one of the most common childhood infections: pooled prevalence data report AOM as among the most common reasons for antibiotic prescribing in childhood, with high lifetime incidence in the first three years of life.^[1] The middle ear fills through a dysfunctional Eustachian tube following viral upper respiratory infection, and fluid becomes purulent.

The bacteriology is dominated by three organisms. In the Finnish otitis media cohort followed from 2 to 24 months, Streptococcus pneumoniae was isolated in 26%, Moraxella catarrhalis in 23% and Haemophilus influenzae in 23% of middle ear aspirates; Haemophilus was rare in first episodes (13%) but rose to about a third from the third episode onward.^[12] This distribution shifted after pneumococcal conjugate vaccination: population data spanning 2000–2018 showed AOM incidence halved (62 to 31 per 1000 population) in the PCV13 era, with antibiotic utilisation falling in parallel.^[6]

References15ShowHide

1. [1]Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children Cochrane Database Syst Rev, 2023.PMID 37965923
2. [2]Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children under 2 years of age N Engl J Med, 2011.PMID 21226576
3. [3]Hoberman A, Paradise JL, Rockette HE, et al. Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children N Engl J Med, 2016.PMID 28002709
4. [4]Marchetti F, Ronfani L, Nibali SC, et al. Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care Arch Pediatr Adolesc Med, 2005.PMID 15997003
5. [5]Venekamp RP, Damoiseaux RAJM, Little P, et al. Topical or oral antibiotics in childhood acute otitis media and ear discharge: a randomized controlled non-inferiority trial Fam Pract, 2024.PMID 38912621
6. [6]Vadlamudi NK, Saatchi A, Patrick DM, et al. Impact of the 13-valent pneumococcal conjugate vaccine on acute otitis media and acute sinusitis epidemiology in British Columbia, Canada J Antimicrob Chemother, 2021.PMID 34021757
7. [7]Paing A, Elliff-O'Shea L, Holland Brown T, et al. Natural history of otitis media with effusion without hearing loss in children under 12 years: a systematic review Arch Dis Child, 2025.PMID 39433333
8. [8]Paing A, Elliff-O'Shea L, Day J, et al. Natural history of otitis media with effusion-related hearing loss in children under 12 years: a systematic review Arch Dis Child, 2024.PMID 39299718
9. [9]Venekamp RP, Mick P, Schilder AG, et al. Grommets (ventilation tubes) for recurrent acute otitis media in children Cochrane Database Syst Rev, 2018.PMID 29741289
10. [10]Azarpazhooh A, Lawrence HP, Shah PS Xylitol for preventing acute otitis media in children up to 12 years of age Cochrane Database Syst Rev, 2016.PMID 27486835
11. [11]Persaud N, Azarpazhooh A, Keown-Stoneman C, et al. Xylitol for the prevention of acute otitis media episodes in children aged 1-5 years: a randomised controlled trial Arch Dis Child, 2024.PMID 37890960
12. [12]Kilpi T, Herva E, Kaijalainen T, et al. Bacteriology of acute otitis media in a cohort of Finnish children followed for the first two years of life Pediatr Infect Dis J, 2001.PMID 11465836
13. [13]de Sévaux JLH, Damoiseaux RA, van de Pol AC, et al. Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children Cochrane Database Syst Rev, 2023.PMID 37594020
14. [14]Uitti JM, Laine MK, Tähtinen PA, et al. Symptoms and otoscopic signs in bilateral and unilateral acute otitis media Pediatrics, 2013.PMID 23359578
15. [15]Hollborn H, Lachmann C, Strüder D, et al. Rise in complications of acute otitis media during and after the COVID-19 pandemic Eur Arch Otorhinolaryngol, 2024.PMID 38709319