Acute otitis media: Etiology, prevention and therapy

Background: Acute otitis media (AOM) is one of the most frequent conditions requiring medical attention in childhood. Objective: This article gives an overview of the current understanding of the etiology, prevention and therapy of AOM. Material and methods: A search of the literature was carried out in the PubMed database. Results: The AOM mainly affects children of preschool age. Physiological immaturity of the Eustachian tube is believed to be a particularly high risk factor for compromised ventilation and infections of the middle ear in infants. Viral infections frequently precede episodes of AOM. Combined viral and bacterial infections are more frequent than infections with a single pathogen. Pneumococci and Haemophilus are the most frequent bacteria causing AOM. Young age, anatomical anomalies of the nose and upper pharynx and smoke exposure are particular risk factors. Vaccination against pneumococci, non-typeable Haemophilus influenzae and grippe are effective in preventing AOM. In contrast, antibiotic therapy has limited effectiveness as the majority of episodes spontaneously wane within several days. This has triggered the watchful waiting strategy to withhold antibiotic therapy for 2–3 days, which effectively reduces the number of antibiotic courses without increasing the risk of complications. Conclusion: The diagnosis and therapy of AOM is one of the most frequent medical tasks in pediatrics. Vaccinations and awatchful waiting strategy for antibiotic therapy in low-risk cases are effective in reducing the burden of disease and the use of antibiotics. This article provides practical recommendations on prevention and therapy. © 2016, Springer-Verlag Berlin Heidelberg.