UMEM Educational Pearls

As we are approaching the winter in the northern hemisphere, the number of visits for ear pain or respiratory symptoms are expected to increase.  The occurrence of acute otitis media (AOM) will also increase, but are these two disease processes related?

Drs. Heikkinen and Chonmaitree published a systematic review of previously reported studies regarding the correlation of these two disease processes (1).  As far back as 1990, studies have shown that up to 94% of pediatric patients diagnosed with AOM have concomitant upper respiratory infection (URI) type symptoms at time of diagnosis (2).   The viral infections most commonly associated with AOM are respiratory syncytial virus, influenza virus, and adenovirus (3).

The most commonly taught risk factors for developing AOM include young age, male gender, multiple siblings, day care attendance, and passive smoking.  These factors are also related to the development of upper respiratory symptoms, and the development of AOM should be thought of as a complication of the upper respiratory infection (4). 

Koivunen et al noted the highest incidence of AOM at day 3 after the onset of an URI, and the median time to diagnosis was day 4 (5). If you see a patient in day 2-4 of an URI, who has started to develop an ear effusion, but not clinical AOM, you may want to consider a “Wait-to-see” treatment option if the patient meets treatment criteria (


(1) Heikkinen T, Chonmaitree T. Importance of Respiratory Viruses in Acute Otitis Media. Clinical Microbiology Reviews. 2003;16(2):230-241.

 (2) Arola M, Ruuskanen O, Ziegler T, Mertsola J, Näntö-Salonen K, Putto-Laurila A, Viljanen MK, Halonen P. Pediatrics. 1990 Dec; 86(6):848-55.
(3) Henderson FW, Collier AM, Sanyal MA, Watkins JM, Fairclough DL, Clyde WA Jr, Denny FW, N Engl J Med. 1982 Jun 10; 306(23):1377-83.
(4) Daly KA, Brown JE, Lindgren BR, Meland MH, Le CT, Giebink GS. Pediatrics. 1999 Jun; 103(6 Pt 1):1158-66.
(5) Koivunen, P., T. Kontiokari, M. Niemelä, T. Pokka, and M. Uhari. 1999. Time to development of acute otitis media during an upper respiratory tract infection in children. Pediatr. Infect. Dis. J. 18:303-305.