We analyzed data from a 14-year longitudinal study of respiratory infections in young children to determine the relative importance of viral respiratory infection and nasopharyngeal colonization with Streptococcus pneumoniae and Haemophilus influenzae as factors influencing the occurrence of acute otitis media with effusion. The incidence of this disorder was increased in children with viral respiratory infections (average relative risk, 3.2; P less than 0.0001). Infection with respiratory syncytial virus, influenza virus (type A or B), and adenovirus conferred a greater risk of otitis media than did infection with parainfluenza virus, enterovirus, or rhinovirus. Colonization of the nasopharynx with Str. pneumoniae or H. influenzae had a lesser effect on the incidence of the disease (average relative risk; 1.5; P less than 0.01). Infections with the viruses more closely associated with acute otitis media (respiratory syncytial virus, adenovirus, and influenza A or B) were correlated with an increased risk of recurrent disease. Prevention of selected otitis-associated viral infections should reduce the incidence of this disease.

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The relationship between the occurrence of otitis media with effusion during the first 3 years of life and subsequent verbal and academic performance was examined in 61 socioeconomically disadvantaged children who attended a research day-care program. Study children were participants in a longitudinal study of child development in which the number of episodes of otitis media and duration of each otitis episode were reported prospectively from infancy. The incidence of otitis media was highest during the first 2 years of life. Bilateral otitis media accounted for 66% of the days with otitis media with effusion. Standardized tests of intelligence and academic performance were administered to the children when they were 3½ to 6 years of age. No evidence of associations between measures of early childhood otitis media experience and these measures of verbal or academic functioning was found in this study population.