Recurrent otitis media

This is a condition in which the patient, most commonly a child, suffers form repeated episodes of acute otitis media, often entailing repeated courses of antibiotics. It can be defined as 3 or more episodes of acute otitis media in 6 months or 4 or more episodes in a year (1).

Often there is a persistent effusion in the middle ear which acts as a bacterial culture medium.

Risk factors associated with recurrent acute otitis media include (1,2):

• first episode of acute otitis media early in life (within 6 months) - a prominent risk factor for recurrence
• male sex
• day care
• not being breastfed
• primary clinical treatment failure
• bilateral disease
• passive smoking
• winter season
• sibling history of recurrent acute otitis media
• craniofacial abnormalities (including Down’s and cleft palate)
• dummy use

Other foci of infection such as sinusitis should be excluded and immune deficiency should be considered. Prophylactic antibiotics, for example amoxicillin, may then be given for up to six months and grommet insertion may also be helpful. NICE has concluded that persons with recurrent acute otitis media should not be excluded from the offer of a delayed or no antibiotic prescribing strategy (3).

Prevention strategies for recurrent acute otitis media should include modification or elimination of controllable risk factors (1).

Reference:

• (1) ICSI (2008) Health care guideline: diagnosis and treatment of otitis media in children. Institute for Clinical Systems Improvement
• (2) Damoiseaux RA et al. Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion. Family Practice 2006;23(1):40-45
• (3) NICE (June 2008). Respiratory tract infections - antibiotic prescribing for self-limiting respiratory tract infections in adults and children in primary care