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Otitis media (OM) is a global health care problem most commonly seen in the pediatric population. Aside from upper respiratory infections, OM is the most commonly rendered diagnosis in the pediatric primary care setting. The majority of children will be diagnosed with at least one episode of acute otitis media (AOM) with rates of incidence peaking at age 2. Various retrospective studies demonstrate a wide berth of incidence, suggesting that 19–62% of children will experience at least one episode of AOM by age 1, and 50–84% of children by age 3.

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While mainly considered a pediatric medical problem, OM does present in the adolescent and adult population, albeit at a lower rate. Approximately 3% to 15% of all-comers with OM presenting to otolaryngologists are adults.

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Over the past decade, in particular, health care discussions have intently focused on cost and consequences of medical conditions and interventions. While the economic implications of OM are largely abstruse, estimates of a single episode of AOM range from $233 to $1330 USD. When considering these figures, OM (including medical and surgical interventions) in the United States costs $3 to 18 billion dollars annually.

Alsarraf R et al. Measuring the indirect and direct costs of acute otitis media. Arch Otolaryngol Head Neck Surg. 1999;125(1). (Description of an economic model using the Otitis Media Diary (OMD) to calculate the indirect and direct costs of a single, medically treated episode of AOM.)
Casselbrant ML, Mandel EM. Epidemiology. In: Evidence-Based Otitis Media. BC Decker, 1999. pp. 117–136. (Book chapter summarizing the overall epidemiology and risk factors of otitis media in the United States.)
Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Surg. 1996;114(4):525–530. (A cost-effectiveness analysis of medial and surgical therapies used in the treatment of young children with otitis media.)

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Essentials of Diagnosis

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  • OM is stratified into two distinct categories: AOM and otitis media with effusion (OME).
  • The most common bacterial pathogens that cause AOM are Streptococcus pneumoniae, Haemophilus influenzae, and Branhamella (moraxella) catarrhalis.
  • OME is defined as the presence of a middle ear effusion for 3 months or more.

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Classification of a disease process is paramount to optimal diagnosis and management. Historically, extensive efforts have been put forth to define OM and its manifestations. Generally, OM refers to an inflammatory process localized to the middle ear cleft. The term “otitis media” can be separated into two distinct categories: AOM and OME.

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AOM is characterized by a rapid onset of signs and symptoms, such as pyrexia and otalgia, leading to inflammation of the middle ear. Traditionally, terms such as acute suppurative or purulent OM have been used interchangeably with AOM. Current recommendations state, however, that AOM is the most accurate term used to describe middle ear inflammation in absence of effusion. Recurrent AOM is defined as: three or more episodes in a 6 month ...

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