Otitis Media

What is otitis media?

Otitis media (OM) includes a range of potentially serious inflammatory middle ear infections which commonly occur during childhood. OM is classified into distinct categories according to symptoms, severity and duration

Acute otitis media (AOM) – generally defined as the presence of middle ear effusion (fluid) accompanied with the rapid onset of one or more signs or symptoms of inflammation in the middle ear, such as ear pain / earache, discharge from the ear, fever and irritability

OM with effusion (OME) – involves fluid behind an intact eardrum without signs or symptoms of infection

Recurrent (ROM) – defined as three or more episodes of AOM during 12 months

Chronic OM (COM) – defined as the occurrence of more than six episodes of AOM in 12 months

Chronic OM with effusion (COME) – OME is defined as chronic when middle ear effusion has been present for at least three months

Chronic suppurative OM (CSOM) – defined as a chronic inflammation of the middle ear in which a perforated eardrum and discharge are present

How common is OM?

OM is one of the most frequent childhood diseases. By the age of three years, it is estimated that three quarters of all children will have had at least one episode of OM and more than one third will have had repeated infections (defined as three or more episodes in one year).

The peak incidence of acute otitis media is among children aged 6–18 months. The age at which the first episode occurs is associated with the child experiencing repeated episodes i.e. the earlier the first episode occurs, the more likely it is to recur.

For example, the prevalence rate of otitis media from 19 kindergartens in Kaohsiung, Taiwan was estimated as 9.82% for all children aged three to six years old. Prevalence rates for older children were:

11.3% for 3-year-olds

12.4% for 4-year-olds

11.8% for 5-year-olds

6.1% for 6-year-olds

What causes OM?

OM occurs when bacteria and / or viruses spread from the nasopharynx (the upper part of the throat) to the middle ear via the Eustachian tube (the tube that links the throat, the nasal passage and the middle ear). As OM is caused by the movement of infectious bacteria from the nasopharynx to the middle ear, it is classed as an infection of the upper respiratory tract.

More than half of all OM cases are caused by bacteria. The two main bacteria causing OM are Streptococcus pneumoniae (S. pneumoniae) and non-typeable Haemophilus influenzae (NTHi):

S. pneumoniae is a leading cause of invasive disease (e.g. pneumonia, meningitis and bacteraemia) as well as upper and lower respiratory tract infections, such as pneumonia, in young children

NTHi is also a frequent cause of respiratory tract infections such as sinusitis, conjunctivitis and pneumonia, and the most common cause of complicated, difficult to treat OM

How is OM diagnosed?

The accurate diagnosis of AOM can be difficult, as many of the symptoms are shared with other infections of the upper respiratory tract.

For a certain diagnosis of AOM, the following criteria should be met:

Rapid onset of signs and symptoms

Presence of fluid in the middle ear

Signs and symptoms of middle-ear inflammation i.e., pain, fever or loss of hearing

What is the burden of OM?

OM infection is often painful for children and can cause significant emotional distress for parents. It also has a considerable negative impact on the quality of life of children and their families

OM can lead to hearing impairment in young children. Several research studies have shown that 70% of children in whom chronic effusion (fluid in the middle ear) lasts for three or more months suffer mild or moderate hearing loss.

The consequences of impaired hearing at critical stages of childhood development include:

Delays in speech and language development

Impaired social development

Learning difficulties

Costs of OM

OM is recognized as a substantial burden on clinical practice and is challenging to treat. Repeated episodes are frequently placing further strain on healthcare resources

In the UK, pneumococcal OM accounts for 15,000 hospitalizations and 630,000 physician visits11, amounting to considerable costs

How is OM currently treated?

OM is the most common childhood illness for which medical advice is sought.1 The approach to the management of OM varies widely across the world as there are no evidence-based, internationally recognised treatment guidelines, despite it being the most common infection for which antibiotics are prescribed.

Concerns about the rising rates of antibiotic resistance and the growing costs of antibiotic prescriptions have highlighted the need for a more conservative approach to the use of antibiotics.

Vaccination in OM

A different approach to the management of OM and its potential consequences is to prevent the first episode from occurring. This is particularly important as some children are ‘otitis prone’ and experience recurrent OM that is associated with pain, repeated courses of antibiotics, hearing impairment and delay in speech and language development.

In addition to protecting children against invasive pneumococcal disease (IPD), GSK’s new PHiD-CV vaccine is the only vaccine that offers protection against a common bacterial pathogen called NTHi. Together with S. pneumoniae, NTHi causes over 40% of otitis media cases.

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