Window of susceptibility for recurrent acute otitis media


A recent study examined the window of susceptibility for recurrent acute otitis media in young children, along with developing predictive models and determining the frequency of tympanostomy tubes use.

The window of susceptibility (WOS) for recurrent acute otitis media (AOM) in young children is small, according to a recent study.

At least 1 AOM infection will occur in 60% of children, with 10% to 15% of children susceptible to recurrent AOM. These children often undergo tube insertion surgery, but the benefits of this surgery are not clearly defined. Tympanic membrane abnormalities and complications may also occur because of tube insertion surgery.

Investigators conducted a study with the primary objective of quantifying cases of recurrent AOM in different age groups. The WOS was defined as 2 or more AOMs occurring closely in time to each other in a child. The secondary objective of the study was the creation of models for predicting AOM recurrence risk and timing.

Children aged about 6 months enrolled in the study and were followed until aged 60 months. The study occurred from June 2006 to August 2017. Recruitment occurred at a primary care pediatric practice in Rochester, New York, with a mixed demographic included. American Academy of Pediatrics guidelines were used to diagnose AOM.

About 85% of AOM diagnoses were based on middle ear fluid collected by tympanocentesis in children aged up to 36 months. Children were reported as otitis prone if they experienced 3 AOM episodes within 6 months, or 4 episodes within 12 months. Data on children aged more than 36 months was not included in the study.

Two AOMs occurring more than 6 months apart were considered separate, making WOS defined as 2 or more AOMs with a period of under 6 months between them. Risk factors recorded included race and ethnicity, sex, breastfeeding siblings in the home, daycare attendance, atopy, smoking in the home, and family history of otitis media.

The mean AOMs among children attending daycare was 2.7, compared 2.0 in children not attending daycare. Children aged younger than 6 months did not often experience AOMs, with 80% of AOMs occurring in children aged 6 to 21 months.

There were 67 children with 2 AOMs, 49 of which had closely spaced AOMs with an average WOS of 1.9 months. Among children with 3 AOMs, the average WOS was 3.6 months. For children with 4 AOMs, the average WOS was 3.9 months.

To predict the expected number of AOMs in the first 3 years of a child’s life, investigators used the child’s age at first AOM and daycare attendance. Models predicted 2.7 additional AOMs on average in children who experienced their first AOM before 6 months, and 1 additional AOM on average in children who experienced their first AOM after 15 months.

About 24% of children with at least 1 AOM met the criteria for otitis prone. Tympanostomy tubes were requested by 31 parents of children after experiencing 3 AOMs.


Bajorski P, Fuji N, Kaur R, Pichichero ME. Window of susceptibility to acute otitis media infection. Pediatrics. 2023;151(2). doi:10.1542/peds.2022-058556

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