Researchers develop model to predict frequency of Acute Otitis Media in future

Recurrent acute otitis media (AOM) occurs most frequently in the first two years of life. This leads to tympanostomy tube surgery.

More data is required to recommend and influence decision-making considering the referral and surgeon endorsement of tympanostomy tube placement in children with recurrent acute otitis media (AOM).

Considering this, a prospective, observational cohort study was conducted by the researchers team led by Peter Bajorski, PhD from Rochester Institute of Technology, to investigate the incidence of recurrent acute otitis media (AOM) incidence about age, daycare attendance influence, and other risk factors with the inclusion of models to predict risk and timing in children who don't get tympanostomy tubes as the secondary objective. The tertiary objective was to assess recurrent AOM natural history after placement of the tympanostomy tube.

The researchers introduced the concept of a window of susceptibility (WOS). This is defined as Acute Otitis Media infections closely spaced in time with no gap of more than six months.

The study summary is as follows:

• The researchers included 286 children with a history of at least 1 AOM.
• The follow-up was done for Children from 6 to 36 months old.
• The diagnosis was confirmed microbiologically.
• The quasi-Poisson generalized linear model was used to predict AOM's total number.
• In children aged 6 to 21 months, 80 % of AOMs occurred.

• Seventy-two per cent of WOS intervals were in about five months, and 97%  of WOS were within ten months.

• Clinically applicable models predicted which children would benefit the most from tympanostomy tubes.
• Significant predictors were children's age at the first AOM and daycare attendance.
• The age of a child when 2, 3, or 4 AOMs had occurred allowed prediction of the number of additional AOMs that might occur.
• 16 of 31 children constituting 52 %, had no AOM after inserting tympanostomy tubes.

To conclude, recurrent Acute Otitis Media (AOM) occurs in a narrow WOS. Based on the child's age and daycare attendance, the number of AOMs can be predicted (at the time of AOM). Tympanostomy tube insertion occurs mostly after the WOS to recurrent AOM has passed, or only one more AOM may be prevented at most.

They said the vaccines (pneumococcal and influenza) reduce the risk of AOM.

The US National Institutes of Health funded the study.

Further reading:

Bajorski, Peter, et al. "Window of Susceptibility to Acute Otitis Media Infection." Pediatrics, American Academy of Pediatrics (AAP), Jan. 2023. Crossref,

https://doi.org/10.1542/peds.2022-058556