Preventing Otitis Media

Recurrent acute otitis media (AOM) is an extremely prevalent disease in young children. Epidemiologic associations suggest that primary prevention or reduction of AOM frequency may be achieved with breast-feeding during infancy, elimination of household tobacco smoking, and use of small rather than large day-care arrangements for infants and toddlers. Secondary antimicrobial prophylaxis with amoxicillin or sulfisoxazole reduces the frequency of recurrent AOM by about 50%, but it does not appear to reduce the duration of otitis media with effusion (OME). Tympanostomy tube insertion is not as effective as amoxicillin in reducing AOM frequency in children without OME. Adenoidectomy appears to be warranted for children who develop recurrent AOM after extrusion of tubes. Vaccines against the common bacteria and viruses causing AOM hold the greatest promise of preventing AOM and blocking the sequence of pathologic events leading to chronic OME and middle ear sequelae. The greatest progress has been made recently with pneumococcal protein conjugate vaccines, and clinical testing is in progress. </jats:p

Progress in Understanding the Pathophysiology of Otitis Media

Otitis media is one of the most common diseases of infants and young children, and its complications and sequelae may persist into adult years. The disease affects at least 7 of every 10 children, with one third of those affected having repeated episodes, and chronic middle ear disease, commonly called otitis media with effusion, developing in 5% to 10% of them. The management of childhood otitis media has changed considerably during the past five decades. Before the introduction of antimicrobial drugs, myringotomy was, and in some countries remains today, the treatment of choice. The introduction of sulfonamides and penicillin four decades ago and their widespread use in treating acute otitis media led to a great reduction in the incidence of suppurative complications. Of the new orally administered antibiotics, many have been found to be efficacious in treating acute otitis media. Sophisticated methods of measuring treatment outcome suggest, however, that there are differences in rates of bacteriologic response to these drugs. Moreover, adjunctive therapies such as decongestants, antihistamines, steroidal and nonsteroidal anti-inflammatory drugs, and topical drugs, in addition to myringotomy and adenoidectomy, have been advocated by some in treating acute and recurrent otitis media. These newer therapeutic interventions have led to controversies regarding management of the disease.</jats:p