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INTRODUCTION

Otitis media (OM) is a global health care concern 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. Most children will be diagnosed with at least 1 episode of acute otitis media (AOM) with rates of incidence peaking at age 2 years. Various retrospective studies demonstrate a wide berth of incidence, suggesting that 19% to 62% of children will experience at least 1 episode of AOM by age 1 year, and 50% to 84% of children by age 2 years. Children with trisomy 21 or cleft palate are particularly at risk with incidence from 60% to 85%.

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 patients with OM presenting to otolaryngologists are adults.

Over the past decade, health care discussions have intently focused on cost and consequences of medical conditions and interventions. Recent studies have shown that children with AOM have an incremental increase in outpatient health care costs of $314 per child annually. Due to the high prevalence of the disease, pediatric AOM alone accounts for approximately $2.88 billion of health care expenses. With conservative estimates that approximately 10% of AOM patients develop chronic otitis media with effusion (OME), it is estimated that direct costs of OME account for $5 billion in health care spending.

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Ahmed  S, Shapiro  NL, Bhattacharyya  N. Incremental health care utilization and costs for acute otitis media in children. Laryngoscope. 2014 Jan;124(1):3301–3305. (Cross-sectional analysis of national health care cost database evaluating the cost of AOM in the post pneumococcal vaccine era.)
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Alsarraf  R,  et al. Measuring the indirect and direct costs of acute otitis media. Arch Otolaryngol Head Neck Surg.[Archives of Otolaryngology Full Text] 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.)
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Casselbrant  ML, Mandel  EM. Epidemiology. In: BC Decker. Evidence-Based Otitis Media. 1999;117–136. (Book chapter summarizing the overall epidemiology and risk factors of otitis media in the United States.)
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Gates  GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Surg. 1996;114(4):525–530. (A cost-effectiveness analysis of medical and surgical therapies used in the treatment of young children with otitis media.)  [PubMed: 8643261]

DEFINITIONS

CLINICAL PEARLS

  • OM is stratified into 2 distinct categories: AOM and OME.

  • OME is defined as the presence of a middle ear effusion. Chronic OME is an effusion present for ≥ 3 months.

The middle ear cleft comprises 3 contiguous components: the eustachian tube, the tympanic cavity (middle ear), and the mastoid air cells. Generally, OM refers to an inflammatory process localized to the middle ear cleft. The term otitis ...

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