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Evidence summaries

Viral Respiratory Infection and Acute Otitis Media

Upper respiratory infection is the main risk factor for acute otitis media. Level of evidence: "A"

A study by Henderson et al in 1982 1 was the first to show a clear relationship between viral upper respiratory infection (URI) and acute otitis media (AOM). This study, which lasted for 14 years, showed that viral infections increased the risk of AOM more that colonization of the nasopharynx by Streptococcus pneumonia or Haemophilus influenzae. The close association of viral infections and AOM was also shown in an extensive study of Ruuskanen et al 2 (altogether 4 524 episodes of acute otitis within 6 years), in which the monthly incidence figures of AOM were found to follow closely the incidence of viral infections, RS virus in particular. In a study by Arola et al 3 comprising 363 children prone to otitis, 94% were found to have rhinitis or cough at the time of AOM diagnosis. In the fourth study by Chonmaitree et al 4 with 294 healthy children observed for one year, a total of 1295 URI episodes and 440 AOM episodes were found. The overall incidence of AOM that complicated URI was 61%. AOM occurred in approximately half of children with URI due to adenovirus, RS virus, or coronavirus and in approximately one-third of those with URI due to influenza or parainfluenza virus, enterovirus, or rhinovirus.

    References

    • Henderson FW, Collier AM, Sanyal MA, Watkins JM, Fairclough DL, Clyde WA Jr, Denny FW. A longitudinal study of respiratory viruses and bacteria in the etiology of acute otitis media with effusion. N Engl J Med 1982 Jun 10;306(23):1377-83. [PubMed]
    • Ruuskanen O, Arola M, Putto-Laurila A, Mertsola J, Meurman O, Viljanen MK, Halonen P. Acute otitis media and respiratory virus infections. Pediatr Infect Dis J 1989 Feb;8(2):94-9. [PubMed]
    • Arola M, Ruuskanen O, Ziegler T, Mertsola J, Näntö-Salonen K, Putto-Laurila A, Viljanen MK, Halonen P. Clinical role of respiratory virus infection in acute otitis media. Pediatrics 1990 Dec;86(6):848-55. [PubMed]
    • Chonmaitree T, Revai K, Grady JJ et al. Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis 2008;46(6):815-23. [PubMed]

Primary/Secondary Keywords