Epidemiology, microbiology and management of otitis media.

Epidemiologic studies indicate that the maximum incidence of otitis media (OM) occurs 6 to 24 months of age. Features associated significantly with recurrent OM include sex (males greater than females), race (white greater than black) and having a sibling with recurrent OM. Persistence of middle ear effusion (MEE) following acute OM is frequent; 40% of children have MEE one month after onset of OM. Streptococcus pneumoniae and Haemophilus influenzae are the most frequent organisms isolated from MEE of children with acute OM. Viruses and mycoplasma are uncommonly present in MEE. Therapy of acute OM includes antibiotics active against the two major organisms. Appropriate management of recurrent episodes of OM or persistent MEE is unclear but current studies include use of prophylactic antimicrobial agents and a multitype pneumococcal vaccine.