Acute Otitis Media: Overview and Risk Factors

Acute otitis media (AOM) is an inflammatory process of the middle ear. The condition may occur at any age, but mainly affects children and peaks between 6 months and 2 years of age. An estimated 30% of all antibiotics prescribed for children in the United States are prescribed for AOM.¹ Common specific symptoms include pain, otorrhea, and temporary hearing loss; vertigo occasionally occurs. Nonspecific findings are more common in young children and include fever, irritability, reduced activity or expressivity, vomiting, diarrhea, and anorexia. Incidence of AOM has been rising in the last 25 to 30 years.²

An upper respiratory infection often precedes acute otitis media, and resultant congestion can obstruct the eustachian tube, creating an accumulation of middle–ear secretions and a potential breeding ground for infections. Spread of infection from the inner ear may result in mastoiditis, meningitis, carotid artery thrombosis, and disease of other contiguous structures. Allergies can contribute to eustachian tube dysfunction and predispose to chronic otitis media.

Risk Factors

Indigenous North American populations have a greater incidence of aggressive AOM. Bottle feeding may also increase risk. Breastfeeding for at least 3 months appears to be protective against AOM.²

Risk factors include:

• Male gender.
• Age <10 years.
• Pacifier use.²
• Day care attendance.
• Exposure to tobacco smoke and air pollution.
• Hereditary factors.
• Low socioeconomic status.
• Fall and winter months.