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.

Compared to symptomatic infection, asymptomatic viral infection in infants is associated with young age, male sex, low viral load, specific viruses, and single virus detection. Asymptomatic viral infection did not result in AOM.

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Purpose of review Acute otitis media (AOM) occurs as a complication of viral upper respiratory tract infection (URI). Bacterial otopathogens and respiratory viruses interact and play important roles in AOM development. Better understanding of viral and bacterial interactions may lead to innovative ways to lessen the burden of this common childhood disease. Recent findings There has been increasing evidence that AOM occurs during URI, even in the absence of nasopharyngeal bacterial colonization. Among the types of viruses associated with AOM, respiratory syncytial virus continues to be the most commonly detected. It is still unclear whether viral load plays an important role in AOM development, but symptomatic URI (as opposed to asymptomatic viral infection) is crucial. Widespread use of bacterial and viral vaccines in young children, including pneumococcal conjugate and influenza vaccines, has led to the reduction in otitis media-related health care use between 2001 and 2011. There has been no new vaccine against respiratory viruses other than influenza. Summary Progress has been made towards reduction of the burden of AOM in the last decade. Success in reducing AOM incidence will rely mainly on prevention of nasopharyngeal otopathogen colonization, as well as reduction in the incidence of viral URI.

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Acute otitis media (AOM) is a polymicrobial disease, which usually occurs as a complication of viral upper respiratory tract infection (URI). While respiratory viruses alone may cause viral AOM, they increase the risk of bacterial middle ear infection and worsen clinical outcomes of bacterial AOM. URI viruses alter Eustachian tube (ET) function via decreased mucociliary action, altered mucus secretion and increased expression of inflammatory mediators among other mechanisms. Transient reduction in protective functions of the ET allows colonizing bacteria of the nasopharynx to ascend into the middle ear and cause AOM. Advances in research help us to better understand the host responses to viral URI, the mechanisms of viral–bacterial interactions in the nasopharynx and the development of AOM. In this review, we present current knowledge regarding viral–bacterial interactions in the pathogenesis and clinical course of AOM. We focus on the common respiratory viruses and their established role in AOM.

With the advent of flexible and rigid fiber-optic technology and modern imaging techniques, and in particularly prenatal diagnostic techniques, nasopharyngeal cysts recognition is more common than previous times and requires an appropriate consideration. Familiarity with these lesions is essential for the pediatric otolaryngologist.

The risk of transient of hypocalcemia in patients undergoing CT is significantly lower than the rate of hypocalcemia in patients undergoing TT.