Elsevier

Vaccine

Volume 26, Supplement 7, 23 December 2008, Pages G2-G4
Vaccine

The burden of otitis media

https://doi.org/10.1016/j.vaccine.2008.11.005Get rights and content

Abstract

Otitis media (OM) is one of the most frequent diseases in young children, one of the most common reasons for a child to visit a physician, and also the most common indication for antibiotic prescribing. OM-related hearing loss due to middle ear effusion can delay language acquisition, alter behaviour, and influence quality of life. Conclusive evidence is, however, lacking. More insight into the individual risk factors is required in order to answer the question of why some children recover from OM spontaneously while others need specific intervention.

Introduction

Otitis media (OM) is one of the most common childhood infections, the leading cause of doctors’ consultations, and the most frequent reason children take antibiotics [1], [2], [3], [4]. OM refers to an inflammation of the middle ear and comprises two main entities: acute OM (AOM) and OM with effusion (OME). AOM is defined as the presence of middle ear effusion in conjunction with the rapid onset of one or more signs or symptoms of inflammation in the middle ear, such as otalgia, otorrhoea, fever, or irritability [5]. OME is defined as fluid in the middle ear without signs or symptoms of an ear infection [5].

This paper will summarize the current state of knowledge regarding the burden of OM.

Section snippets

Epidemiology

At least 80% of children will have experienced one or more episodes of OM by the age of 3 years [6]. The peak incidence of AOM occurs during the second half of the first year of life [6]; a recently published study reported means of 1.9, 1.7, and 1.1 episodes of OM per year for children aged 6–11, 12–23, and 24–35 months, respectively [7]. There is clearly a degree of clinical overlap between children with OME and children with AOM. Children with OME suffer from up to five times more episodes

Risk factors

OM is a multifactorial disease, resulting from interplay between the microbial (viral and bacterial) load and immune response. All factors known to cause OM relate to these two core elements: host factors, such as age, genetic predisposition, and atopy, relate to the impaired immune system, whereas environmental factors, such as siblings, day-care attendance, and season, relate to microbial load (Fig. 1). The Eustachian tube plays a central role as it is the port of entry to the middle ear for

Antibiotics and mastoiditis

OM is the most frequent reason children consume antibiotics [1], [2], [3], [4]. Evidence from an individual patient data meta-analysis suggests that antibiotics are more likely to be beneficial in children aged <2 years with bilateral AOM, and in children with AOM and otorrhoea. For most other children, an observational policy seems justified [13]. Furthermore, prescribing antibiotics is known to encourage attendance in future episodes [14], increase pressure on clinicians to prescribe,

Sequelae

It has been hypothesized that OM-related hearing loss due to effusion can delay language acquisition, alter behaviour, and influence quality of life (QoL). Disturbance in vestibular balance and gross motor function can also occur [17]. The degree of conductive hearing loss associated with OM is 10–40 dB. However, conclusive evidence that hearing loss associated with OM indeed causes language delay, alters behaviour, and influences QoL is absent. A meta-analysis using different types of studies

Costs

The OM spectrum is associated with a significant economic burden. There have been several studies on the costs attributable to disease caused by OM [20], [21], [22], [23], [24]. Annual costs for OM have been estimated at $3–5 billion for the USA, with estimated costs per episode of AOM varying from $108 to $1330 [25]. The true impact is probably underestimated because indirect costs may be substantially higher [20]. Indirect, non-medical costs, such as lost working days and loss in productivity

Epilogue

The ideal intervention, either preventive or curative, for OM would be widely available, non-toxic, and rapidly effective at clearing the effusion, and would have a sustained effect. Such an intervention does not yet exist, so there is an urgent need for creativity with respect to the design and testing of new directions for treatment that are based on modern insights into the pathophysiology of OM. More insight into the pathogenesis of disease is required in order to answer the question of why

Conflict of Interest

M.M.R. has received honoraria from GlaxoSmithKline to attend and present at a CME event at The European Society of Pediatric Otolaryngology in Budapest, 2008.

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