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Acute otitis media (AOM) is defined as an acute illness marked by the presence of middle ear fluid and inflammation of the mucosa that lines the middle ear space. Otitis media with effusion (OME) is defined by the presence of middle ear fluid without acute signs of illness and usually follows AOM but may also occur as a result of barotrauma or allergy. Synonyms for OME include serous otitis, secretory otitis, glue ear, and middle ear catarrh. Less common chronic variations of otitis media include permanent perforation of the tympanic membrane, and perforation or retraction of the tympanic membrane with trapped epithelium that is unable to spontaneously clear desquamated debris, forming a cholesteatoma. This may occur in the presence of an intact tympanic membrane. Both perforations and cholesteatoma may be associated with recurrent foul-smelling otorrhea, termed chronic suppurative otitis media.


Infection may spread from the middle ear space to contiguous structures such as the mastoid air cells, the petrous bone, and the inner ear. For detailed discussions of the various facets of infections of the middle ear, the reader is referred to the text Otitis Media in Infants and Children by the author and Charles D. Bluestone1 and two Clinical Practice Guidelines: Diagnosis and Management of Acute Otitis Media2 and Otitis Media with Effusion,3 prepared by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians.


Epidemiology and Genetics


Acute otitis media has been a disease burden for children since the beginning of time. Examination of Egyptian mummies revealed perforations of the tympanic membranes and destruction of the mastoid.4 Before the introduction of antimicrobial agents, AOM was a frequent reason for hospitalization of infants and children; in 1932, AOM, mastoiditis, and intracranial complications were the admitting diagnoses for 27% of pediatric admissions to Bellevue Hospital in New York City.5 The introduction of the sulfonamides in 1936, penicillin in the 1940s, and the many broad-spectrum antimicrobial agents in the 1950s substantially reduced hospitalizations for suppurative complications of AOM.


Previous longitudinal studies are a rich source of information about the disease in specific populations but three factors are likely to further alter the epidemiology of otitis media in the United States since 2000: (1) introduction of the 7-valent conjugate pneumococcal vaccine (PCV7) in the United States in 2000, and later in countries throughout the world, which has reduced the number of episodes of vaccine-type pneumococcal acute otitis media (AOM) and decreased the incidence of severe and recurrent disease; (2) publication of management guidelines by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) in 2004, which presented uniform criteria for diagnosis, choice of antimicrobial agents, and recommendations for use or withholding of antimicrobial agents for children with AOM2; and (3) programs developed by the Centers for Disease Control (CDC) and advocacy groups to inform physicians ...

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