35.2.2  Causes, transmission and risk factors for acute otitis media

The two predominant bacteria that cause otitis media include Streptococcus pneumoniae and Haemophilus influenzae type b, both of which can be prevented by immunization. It can also be caused by a viral vaccine-preventable disease, which you learned about in Study Session 4 of this Module.

Immunization against bacterial infections caused by Haemophilus influenzae type b is included in the routine EPI schedule for all children in Ethiopia; immunization against Streptococcus pneumoniae infection will become available soon.

  • Can you recall which vaccine-preventable disease is transmitted by airborne droplets and may lead to acute otitis media (AOM) as one of its complications?

  • Measles is associated with several complications in young children, including AOM and pneumonia.

AOM is transmitted by airborne spread of the causative infectious agents in droplets, sprayed into the air when a sick person coughs or sneezes. The infection in the new host usually begins with a common cold, sore throat or measles.The presence of certain risk factors makes babies and young children more vulnerable to developing AOM (see Box 35.1).

Box 35.1  Risk factors for acute otitis media

  • Age: most cases are below five years of age
  • Family history of otitis media
  • Winter season
  • Living in overcrowded conditions where other children have coughs or runny noses
  • Indoor air pollution from cooking fires (Figure 35.4) and/or tobacco smoke
  • Bottle-feeding a baby (breastfeeding offers some protection from URIs)
  • Poor nutrition, particularly when the child is not exclusively breastfed
  • HIV-infection in the child.
Smoke from indoor cooking fires escaping through the roof
Figure 35.4  Smoke from indoor cooking fires escapes from these traditional Ethiopian round houses (tukul); indoor smoke pollution increases the risk of pneumonia and AOM. (Photo: Basiro Davey)

35.2.1  How does acute otitis media affect hearing?

35.2.3  Clinical manifestations, diagnosis and complications of acute otitis media