Otitis media affects nearly all children worldwide. Despite an enormous amount of research, our understanding of this common condition continues to be challenged.
New pathogens involved in otitis media are still being identified. The importance of interactions between viral and bacterial infection and the role of new vaccines need to be clarified.
The proposal that bacteria can become more resistant to therapy through biofilm formation and intracellular infection could have important implications for treatment.
The most important clinical research findings have been summarised in systematic reviews. In developed countries, research supporting “watchful waiting” of otitis media with effusion and acute otitis media have had most impact on evidence-based clinical practice guidelines.
Indigenous Australian children remain at risk of more severe otitis media. Research programs targeting this population have been well supported. Unfortunately, interventions that can dramatically improve outcomes have remained elusive.
For children at high risk of otitis media, health care services should concentrate on accurate diagnosis, antibiotic treatment of suppurative infections, and scheduled follow-up of affected children.
Despite the lack of recent studies, strategies to minimise the impact the hearing loss associated with otitis media are important. Improvements in education, hygiene practices, and living conditions are likely to reduce the incidence and severity of otitis media. Studies of these types of interventions are needed.
- 1. Couzos S, Metcalf S, Murray R. Systematic review of existing evidence and primary care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Canberra: Office for Aboriginal and Torres Strait Islander Health Services, Commonwealth Department of Health and Family Services, 2001.
- 2. Morris P, Ballinger D, Leach A, et al. Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Canberra: Office for Aboriginal and Torres Strait Islander Health Services Commonwealth Department of Health and Family Services, 2001.
- 3. Palmu AA, Saukkoriipi PA, Lahdenkari MI, et al. Does the presence of pneumococcal DNA in middle-ear fluid indicate pneumococcal etiology in acute otitis media? J Infect Dis 2004; 189: 775-784.
- 4. Williams JV, Wang CK, Yang CF, et al. The role of human metapneumovirus in upper respiratory tract infections in children: a 20-year experience. J Infect Dis 2006; 193: 387-395.
- 5. Williams JV, Tollefson SJ, Nair S, Chonmaitree T. Association of human metapneumovirus with acute otitis media. Int J Pediatr Otorhinolaryngol 2006; 70: 1189-1193.
- 6. Leskinen K, Hendolin P, Virolainen-Julkunen A, et al. The clinical role of Alloiococcus otitidis in otitis media with effusion. Int J Pediatr Otorhinolaryngol 2002; 66: 41-48.
- 7. Leskinen K, Hendolin P, Virolainen-Julkunen A, et al. Alloiococcus otitidis in acute otitis media. Int J Pediatr Otorhinolaryngol 2004; 68: 51-56.
- 8. Harimaya A, Takada R, Hendolin PH, et al. High incidence of Alloiococcus otitidis in children with otitis media, despite treatment with antibiotics. J Clin Microbiol 2006; 44: 946-949.
- 9. Ashhurst-Smith C, Hall ST, Walker P, et al. Isolation of Alloiococcus otitidis from Indigenous and non-Indigenous Australian children with chronic otitis media with effusion. FEMS Immunol Med Microbiol 2007; 51: 163-170.
- 10. Post JC. Direct evidence of bacterial biofilms in otitis media. Laryngoscope 2001; 111: 2083-2094.
- 11. Hall-Stoodley L, Hu FZ, Gieseke A, et al. Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media. JAMA 2006; 296: 202-211.
- 12. Vlastarakos PV, Nikolopoulos TP, Maragoudakis P, et al. Biofilms in ear, nose, and throat infections: how important are they? Laryngoscope 2007; 117: 668-673.
- 13. Coates H, Thornton R, Langlands J, et al. The role of chronic infection in children with otitis media with effusion: evidence for intracellular persistence of bacteria. Otolaryngol Head Neck Surg 2008; 138: 778-781.
- 14. Jansen AG, Hak E, Veenhoven RH, et al. Pneumococcal conjugate vaccines for preventing otitis media. Cochrane Database Syst Rev 2009; (2): CD001480.
- 15. Prymula R, Peeters P, Chrobok V, et al. Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet 2006; 367: 740-748.
- 16. Rosenfeld RM, Bluestone CD. Evidence-based otitis media. Hamilton, Ont: BC Decker, 1999.
- 17. Little P, Gould C, Williamson I, et al. Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. BMJ 2001; 322: 336-342.
- 18. Spiro DM, Tay KY, Arnold DH, et al. Wait-and-see prescription for the treatment of acute otitis media: a randomized controlled trial. JAMA 2006; 296: 1235-1241.
- 19. Rovers MM, Glasziou P, Appelman CL, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet 2006; 368: 1429-1435.
- 20. Rovers MM, Black N, Browning GG, et al. Grommets in otitis media with effusion: an individual patient data meta-analysis. Arch Dis Child 2005; 90: 480-485.
- 21. Rob MI, Westbrook JI, Taylor R, Rushworth R. Increased rates of ENT surgery among young children: have clinical guidelines made a difference? J Paediatr Child Health 2004; 40: 627-632.
- 22. Pan Y, Henderson J, Britt H. Antibiotic prescribing in Australian general practice: how has it changed from 1990–91 to 2002–03? Respir Med 2006; 100: 2004-2011.
- 23. Cripps AW, Kyd J. Bacterial otitis media: current vaccine development strategies. Immunol Cell Biol 2003; 81: 46-51.
- 24. Krishnamurthy A, McGrath J, Cripps AW, Kyd JM. The incidence of Streptococcus pneumoniae otitis media is affected by the polymicrobial environment particularly Moraxella catarrhalis in a mouse nasal colonisation model. Microbes Infect 2009; 11: 545-553.
- 25. Leach AJ, Boswell JB, Asche V, et al. Bacterial colonization of the nasopharynx predicts very early onset and persistence of otitis media in Australian Aboriginal infants. Pediatr Infect Dis J 1994; 13: 983-989.
- 26. Lehmann D, Arumugaswamy A, Elsbury D, et al. The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical considerations. Paediatr Perinat Epidemiol 2008; 22: 60-71.
- 27. Stuart J, Butt H, Walker P. The microbiology of glue ear in Australian Aboriginal children. J Paediatr Child Health 2003; 39: 665-667.
- 28. Jacoby P, Watson K, Bowman J, et al. Modelling the co-occurrence of Streptococcus pneumoniae with other bacterial and viral pathogens in the upper respiratory tract. Vaccine 2007; 25: 2458-2464.
- 29. Morris PS, Leach AJ, Silberberg P, et al. Otitis media in young Aboriginal children from remote communities in northern and central Australia: a cross-sectional survey. BMC Pediatr 2005; 5: 27.
- 30. Jacoby PA, Coates HL, Arumugaswamy A, et al. The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie–Boulder region of Western Australia. Med J Aust 2008; 188: 599-603. <MJA full text>
- 31. Ho D, Rotenberg BW, Berkowitz RG. The relationship between acute mastoiditis and antibiotic use for acute otitis media in children. Arch Otolaryngol Head Neck Surg 2008; 134: 45-48.
- 32. Taylor MF, Berkowitz RG. Indications for mastoidectomy in acute mastoiditis in children. Ann Otol Rhinol Laryngol 2004; 113: 69-72.
- 33. Jassar P, Murray P, Wabnitz D, Heldreich C. The posterior attic: an observational study of Aboriginal Australians with chronic otitis media (COM) and a theory relating to the low incidence of cholesteatomatous otitis media versus the high rate of mucosal otitis media. Int J Pediatr Otorhinolaryngol 2006; 70: 1165-1167.
- 34. Semple CW, Mahadevan M, Berkowitz RG. Extensive acquired cholesteatoma in children: when the penny drops. Ann Otol Rhinol Laryngol 2005; 114: 539-542.
- 35. Gunasekera H, Knox S, Morris P, et al. The spectrum and management of otitis media in Australian indigenous and nonindigenous children: a national study. Pediatr Infect Dis J 2007; 26: 689-692.
- 36. Steinmann K, Babl FE. Antibiotic prescribing rates for acute otitis media in a paediatric emergency department. J Paediatr Child Health 2006; 42: 204-205.
- 37. Eikelboom RH, Mbao MN, Coates HL, et al. Validation of tele-otology to diagnose ear disease in children. Int J Pediatr Otorhinolaryngol 2005; 69: 739-744.
- 38. Lehmann D, Tennant MT, Silva DT, et al. Benefits of swimming pools in two remote Aboriginal communities in Western Australia: intervention study. BMJ 2003; 327: 415-419.
- 39. Keogh T, Kei J, Driscoll C, et al. Measuring the ability of school children with a history of otitis media to understand everyday speech. J Am Acad Audiol 2005; 16: 301-311.
- 40. Armstrong JE, Laing DG, Wilkes FJ, Laing ON. Olfactory function in Australian Aboriginal children and chronic otitis media. Chem Senses 2008; 33: 503-507.
- 41. Jones R, Smith F. Fighting disease with fruit. Aust Fam Physician 2007; 36: 863-864.
- 42. Chow Y, Wabnitz DA, Ling J. Quality of life outcomes after ventilating tube insertion for otitis media in an Australian population. Int J Pediatr Otorhinolaryngol 2007; 71: 1543-1547.
- 43. Spilsbury K, Kadhim AL, Semmens JB, Lannigan FJ. Decreasing rates of middle ear surgery in Western Australian children. Arch Otolaryngol Head Neck Surg 2006; 132: 1216-1220.
- 44. Kadhim AL, Spilsbury K, Semmens JB, et al. Adenoidectomy for middle ear effusion: a study of 50,000 children over 24 years. Laryngoscope 2007; 117: 427-433.
- 45. Mak D, MacKendrick A, Bulsara M, et al. Outcomes of myringoplasty in Australian Aboriginal children and factors associated with success: a prospective case series. Clin Otolaryngol Allied Sci 2004; 29: 606-611.
- 46. O’Leary S, Veldman JE. Revision surgery for chronic otitis media: recurrent-residual disease and hearing. J Laryngol Otol 2002; 116: 996-1000.
- 47. Couzos S, Lea T, Mueller R, et al. Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double-blind randomised controlled trial. Med J Aust 2003; 179: 185-190. <MJA full text>
- 48. Leach A, Wood Y, Gadil E, et al. Topical ciprofloxin versus topical framycetin-gramicidin-dexamethasone in Australian Aboriginal children with recently treated chronic suppurative otitis media: a randomized controlled trial. Pediatr Infect Dis J 2008; 27: 692-698.
- 49. Leach AJ, Morris PS, Mathews JD. Compared with placebo, long-term antibiotics resolve otitis media with effusion (OME) and prevent acute otitis media with perforation (AOMwiP) in a high-risk population: a randomized controlled trial. BMC Pediatr 2008; 8: 23.
- 50. Mackenzie GA, Carapetis JR, Leach AJ, Morris PS. Pneumococcal vaccination and otitis media in Australian Aboriginal infants: comparison of two birth cohorts before and after introduction of vaccination. BMC Pediatr 2009; 9: 14.
- 51. Watson K, Carville K, Bowman J, et al. Upper respiratory tract bacterial carriage in Aboriginal and non-Aboriginal children in a semi-arid area of Western Australia. Pediatr Infect Dis J 2006; 25: 782-790.
- 52. Smith-Vaughan H, Byun R, Nadkarni M, et al. Measuring nasal bacterial load and its association with otitis media. BMC Ear Nose Throat Disord 2006; 6: 10.
- 53. Stubbs E, Hare K, Wilson C, et al. Streptococcus pneumoniae and noncapsular Haemophilus influenzae nasal carriage and hand contamination in children: a comparison of two populations at risk of otitis media. Pediatr Infect Dis J 2005; 24: 423-428.
- 54. Coates H. Chronic suppurative otitis media without cholesteatoma. In: Alper CM, Bluestone CD, Dohar J, et al, editors. Advanced therapy of otitis media. Hamilton, Ont: BC Decker, 2004: 299-305.
- 55. Vijayasekaran S, Thornton R, Prosser K, et al. Alloiococcus otitidis in otitis media [abstract]. American Society of Pediatric Otolaryngology Scientific Program; 2007 Apr 27–29; San Diego.
- 56. Lehmann D, Weeks S, Jacoby P, et al. Absent otoacoustic emissions predict otitis media in young Aboriginal children: a birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia. BMC Pediatr 2008; 8: 32.
- 57. Del Mar CB, Glasziou PP. Ways of using evidence-based medicine in general practice. Med J Aust 2001; 174: 347-350.
- 58. Bolt P, Barnett P, Babl FE, Sharwood LN. Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch Dis Child 2008; 93: 40-44.
- 59. Straus SE, Sackett DL. Using research findings in clinical practice. BMJ 1998; 317: 339-342.
- 60. Gunasekera H, Morris PS, McIntyre P, Craig JC. Management of children with otitis media: a summary of current systematic review evidence. J Paediatr Child Health 2009; Sep 14. [Epub ahead of print].
- 61. Gruen RL, Morris PS, McDonald EL, Bailie RS. Making systematic reviews more useful for policy-makers. Bull World Health Organ 2005; 83: 480.
- 62. Cripps AW, Otczyk DC, Kyd JM. Bacterial otitis media: a vaccine preventable disease? Vaccine 2005; 23: 2304-2310.
- 63. Leach AJ, Morris PS. The burden and outcome of respiratory tract infection in Australian and Aboriginal children. Pediatr Infect Dis J 2007; 26 (10 Suppl): S4-S7.
- 64. Emonts M, Veenhoven RH, Wiertsema SP, et al. Genetic polymorphisms in immunoresponse genes TNFA, IL6, IL10, and TLR4 are associated with recurrent acute otitis media. Pediatrics 2007; 120: 814-823.
- 65. Simpson SA, Thomas CL, van der Linden MK, et al. Identification of children in the first four years of life for early treatment for otitis media with effusion. Cochrane Database Syst Rev 2007; (1): CD004163.
- 66. Williams C, Coates H, Pascoe E, et al. Middle ear disease in Aboriginal children in Perth: analysis of hearing screening data 1998–2004. Med J Aust. In press.
- 67. Roos K, Hakansson EG, Holm S. Effect of recolonisation with “interfering” alpha streptococci on recurrences of acute and secretory otitis media in children: randomised placebo controlled trial. BMJ 2001; 322: 210-212.
- 68. Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ 1996; 313: 1180-1184.
- 69. Kanemaru SI, Umeda H, Kitani Y, et al. Innovative regenerative treatment for the tympanic membrane perforation [abstract]. Triological Society 112th Annual Meeting; 2009 May 28–30; Phoenix, Ariz.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.