Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.

More than 60% of episodes of symptomatic URI among young children were complicated by AOM and/or OME. Young age and specific virus types were predictors of URI complicated by AOM. For young children, the strategy to prevent OM should involve prevention of viral URI. The strategy may be more effective if the priority is given to development of means to prevent URI associated with adenovirus and respiratory syncytial virus.

Respiratory syncytial virus is the principal virus invading the middle ear during acute otitis media. An effective vaccine against upper respiratory tract infections caused by respiratory syncytial virus may reduce the incidence of acute otitis media in children.

Acute otitis media is usually considered a simple bacterial infection that is treated with antibiotics. However, ample evidence derived from studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in the etiology and pathogenesis of acute otitis media. Viral infection of the upper respiratory mucosa initiates the whole cascade of events that finally leads to the development of acute otitis media as a complication. The pathogenesis of acute otitis media involves a complex interplay between viruses, bacteria, and the host’s inflammatory response. In a substantial number of children, viruses can be found in the middle-ear fluid either alone or together with bacteria, and recent studies indicate that at least some viruses actively invade the middle ear. Viruses appear to enhance the inflammatory process in the middle ear, and they may significantly impair the resolution of otitis media. Prevention of the predisposing viral infection by vaccination against the major viruses would probably be the most effective way to prevent acute otitis media. Alternatively, early treatment of the viral infection with specific antiviral agents would also be effective in reducing the occurrence of acute otitis media

Importance Otitis media (OM) is a leading cause of pediatric healthcare visits and the most frequent reason children consume antibiotics or undergo surgery. During recent years, several interventions have been introduced aiming to decrease OM burden. Objective To study the trend in OM-related healthcare utilization in the United States, during the pneumococcal conjugated vaccine (PCV) era (2001-2011). Design and Participants Analysis of an insurance claims database of a large, nationwide managed healthcare plan. Enrolled children ≤6 years with OM visit(s) were identified. Outcome measures Annual OM visit rates, OM-related complications and surgical interventions. Results Overall, 7.82 million unique children (5.51 million child-years) contributed 6.21 million primary OM visits; 52% were boys, and 48% were <2 years. There was a downward trend in OM visit rates from 2004-2011, with a significant drop that coincided with the advent of PCV-13 in 2010. The observed OM visit rates in 2010 (1.00/child-year) and 2011 (0.81) were lower than the projected rates, based on the 2005-2009 trend, had there been no intervention (P<0.001). Recurrent OM (≥3 OM within 6 months look-back) rates decreased at 0.003/ child-year in 2001-2009 (95% CI=0.002-0.004) and at 0.018/child-year in 2010-2011 (0.008-0.028). In the PCV-13 pre-market years, there was stable rate ratio (RR) between OM visit rates in children aged <2 years and of those aged 2-6 years (RRs=1.38; 95% CI: 1.38-1.39); RR decreased significantly (P<0.001), during the transition year 2010 (RR=1.32; 95% CI: 1.31-1.33) and the post-market year 2011 (RR =1.01; 95%; CI: 1.00-1.02). Tympanic membrane (TM) perforation/otorrhea rates gradually increased (from 3,721/100,000 OM child-years in 2001 to 4,542 in 2011; P<0.001); the increase was significant only in the older children group. Mastoiditis rates substantially decreased (from 61/100,000 child-years in 2008 to 37 in 2011; P<0.001). Ventilating tube insertion rate decreased by 19% from 2010 to 2011 (P=0.03). Conclusions There was an overall downward trend in OM-related healthcare utilization from 2001-2011. The significant reduction in OM visit rates in 2010-2011 in children <2 years coincided with the advent of PCV-13. While TM perforation/otorrhea rates steadily increased, mastoiditis and ventilating tube insertion rates decreased in the last years of the study.