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Acute otitis media in children: Prevention of recurrence

Jerome O Klein, MD
Stephen Pelton, MD
Section Editors
Sheldon L Kaplan, MD
Glenn C Isaacson, MD, FAAP
Deputy Editor
Mary M Torchia, MD


Prevention is an important part of the management strategy for the child with severe and recurrent acute otitis media (AOM) and the child who is at risk for severe and recurrent AOM.

The prevention of AOM will be reviewed here. Other topics related to otitis media are presented separately:

(See "Acute otitis media in children: Epidemiology, microbiology, clinical manifestations, and complications" and "Acute otitis media in children: Diagnosis" and "Acute otitis media in children: Treatment".)

(See "Otitis media with effusion (serous otitis media) in children: Clinical features and diagnosis" and "Otitis media with effusion (serous otitis media) in children: Management".)

(See "External otitis: Pathogenesis, clinical features, and diagnosis" and "External otitis: Treatment".)

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Literature review current through: Sep 2017. | This topic last updated: Sep 04, 2017.
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  1. Bluestone CD. Role of surgery for otitis media in the era of resistant bacteria. Pediatr Infect Dis J 1998; 17:1090.
  2. Casselbrant ML, Kaleida PH, Rockette HE, et al. Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J 1992; 11:278.
  3. American Academy of Pediatrics. Antimicrobial prophylaxis. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.959.
  4. Pichichero ME. Ten-Year Study of the Stringently Defined Otitis-prone Child in Rochester, NY. Pediatr Infect Dis J 2016; 35:1033.
  5. Marom T, Tan A, Wilkinson GS, et al. Trends in otitis media-related health care use in the United States, 2001-2011. JAMA Pediatr 2014; 168:68.
  6. Giebink GS. Otitis media prevention: non-vaccine prophylaxis. Vaccine 2000; 19 Suppl 1:S129.
  7. Klein JO. Nonimmune strategies for prevention of otitis media. Pediatr Infect Dis J 2000; 19:S89.
  8. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics 2013; 131:e964.
  9. Zhang Y, Xu M, Zhang J, et al. Risk factors for chronic and recurrent otitis media-a meta-analysis. PLoS One 2014; 9:e86397.
  10. Paradise JL. Antimicrobial prophylaxis for recurrent acute otitis media. Ann Otol Rhinol Laryngol Suppl 1992; 155:33.
  11. de Hoog ML, Fortanier AC, Smit HA, et al. Impact of Early-Onset Acute Otitis Media on Multiple Recurrences and Associated Health Care Use. J Pediatr 2016; 177:286.
  12. Friedel V, Zilora S, Bogaard D, et al. Five-year prospective study of paediatric acute otitis media in Rochester, NY: modelling analysis of the risk of pneumococcal colonization in the nasopharynx and infection. Epidemiol Infect 2014; 142:2186.
  13. Gisselsson-Solén M, Henriksson G, Hermansson A, Melhus A. Risk factors for carriage of AOM pathogens during the first 3 years of life in children with early onset of acute otitis media. Acta Otolaryngol 2014; 134:684.
  14. Shimada J, Yamanaka N, Hotomi M, et al. Household transmission of Streptococcus pneumoniae among siblings with acute otitis media. J Clin Microbiol 2002; 40:1851.
  15. Kvaerner KJ, Nafstad P, Hagen JA, et al. Early acute otitis media and siblings' attendance at nursery. Arch Dis Child 1996; 75:338.
  16. Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: tympanostomy tubes in children--executive summary. Otolaryngol Head Neck Surg 2013; 149:8.
  17. Avanzini AM, Castellazzi AM, Marconi M, et al. Children with recurrent otitis show defective IFN gamma-producing cells in adenoids. Pediatr Allergy Immunol 2008; 19:523.
  18. Uhari M, Mäntysaari K, Niemelä M. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996; 22:1079.
  19. Sarasoja I, Jokinen J, Lahdenkari M, et al. Long-term effect of pneumococcal conjugate vaccines on tympanostomy tube placements. Pediatr Infect Dis J 2013; 32:517.
  20. Nuorti JP, Whitney CG, Centers for Disease Control and Prevention (CDC). Prevention of pneumococcal disease among infants and children - use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1.
  21. Straetemans M, Sanders EA, Veenhoven RH, et al. Review of randomized controlled trials on pneumococcal vaccination for prevention of otitis media. Pediatr Infect Dis J 2003; 22:515.
  22. American Academy of Pediatrics. Committee on Infectious Diseases. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics 2000; 106:362.
  23. Hoberman A, Marchant CD, Kaplan SL, Feldman S. Treatment of acute otitis media consensus recommendations. Clin Pediatr (Phila) 2002; 41:373.
  24. Veenhoven R, Bogaert D, Uiterwaal C, et al. Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study. Lancet 2003; 361:2189.
  25. Black S, Shinefield H, Fireman B, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J 2000; 19:187.
  26. Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001; 344:403.
  27. Taylor S, Marchisio P, Vergison A, et al. Impact of pneumococcal conjugate vaccination on otitis media: a systematic review. Clin Infect Dis 2012; 54:1765.
  28. Fireman B, Black SB, Shinefield HR, et al. Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J 2003; 22:10.
  29. Palmu AA, Verho J, Jokinen J, et al. The seven-valent pneumococcal conjugate vaccine reduces tympanostomy tube placement in children. Pediatr Infect Dis J 2004; 23:732.
  30. Grijalva CG, Poehling KA, Nuorti JP, et al. National impact of universal childhood immunization with pneumococcal conjugate vaccine on outpatient medical care visits in the United States. Pediatrics 2006; 118:865.
  31. Zhou F, Shefer A, Kong Y, Nuorti JP. Trends in acute otitis media-related health care utilization by privately insured young children in the United States, 1997-2004. Pediatrics 2008; 121:253.
  32. Poehling KA, Szilagyi PG, Grijalva CG, et al. Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine. Pediatrics 2007; 119:707.
  33. Sugino H, Tsumura S, Kunimoto M, et al. Influence of Pneumococcal Conjugate Vaccine on Acute Otitis Media with Severe Middle Ear Inflammation: A Retrospective Multicenter Study. PLoS One 2015; 10:e0137546.
  34. McEllistrem MC, Adams JM, Patel K, et al. Acute otitis media due to penicillin-nonsusceptible Streptococcus pneumoniae before and after the introduction of the pneumococcal conjugate vaccine. Clin Infect Dis 2005; 40:1738.
  35. Pelton SI, Loughlin AM, Marchant CD. Seven valent pneumococcal conjugate vaccine immunization in two Boston communities: changes in serotypes and antimicrobial susceptibility among Streptococcus pneumoniae isolates. Pediatr Infect Dis J 2004; 23:1015.
  36. Cohen R, Levy C, Bingen E, et al. Impact of 13-valent pneumococcal conjugate vaccine on pneumococcal nasopharyngeal carriage in children with acute otitis media. Pediatr Infect Dis J 2012; 31:297.
  37. Kaplan SL, Center KJ, Barson WJ, et al. Multicenter surveillance of Streptococcus pneumoniae isolates from middle ear and mastoid cultures in the 13-valent pneumococcal conjugate vaccine era. Clin Infect Dis 2015; 60:1339.
  38. Ben-Shimol S, Givon-Lavi N, Leibovitz E, et al. Near-elimination of otitis media caused by 13-valent pneumococcal conjugate vaccine (PCV) serotypes in southern Israel shortly after sequential introduction of 7-valent/13-valent PCV. Clin Infect Dis 2014; 59:1724.
  39. Gisselsson-Solén M, Melhus A, Hermansson A. Pneumococcal vaccination in children at risk of developing recurrent acute otitis media - a randomized study. Acta Paediatr 2011; 100:1354.
  40. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2017-18 Influenza Season. MMWR Recomm Rep 2017; 66:1.
  41. Pappas DE, Owen Hendley J. Otitis media. A scholarly review of the evidence. Minerva Pediatr 2003; 55:407.
  42. Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev 2015; :CD010089.
  43. Williams RL, Chalmers TC, Stange KC, et al. Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion. A meta-analytic attempt to resolve the brouhaha. JAMA 1993; 270:1344.
  44. Leach AJ, Morris PS. Antibiotics for the prevention of acute and chronic suppurative otitis media in children. Cochrane Database Syst Rev 2011; :CD00401.
  45. Teele DW, Klein JO, Word BM, et al. Antimicrobial prophylaxis for infants at risk for recurrent acute otitis media. Vaccine 2000; 19 Suppl 1:S140.
  46. Dowell SF, Marcy SM, Phillips WR, et al. Otitis media--principles of judicious use of antimicrobial agents. Pediatrics 1998; 101 Suppl 1:165.
  47. Brook I, Gober AE. Prophylaxis with amoxicillin or sulfisoxazole for otitis media: effect on the recovery of penicillin-resistant bacteria from children. Clin Infect Dis 1996; 22:143.
  48. Berman S, Nuss R, Roark R, et al. Effectiveness of continuous vs. intermittent amoxicillin to prevent episodes of otitis media. Pediatr Infect Dis J 1992; 11:63.
  49. Barnett ED, Teele DW, Klein JO, et al. Comparison of ceftriaxone and trimethoprim-sulfamethoxazole for acute otitis media. Greater Boston Otitis Media Study Group. Pediatrics 1997; 99:23.
  50. Leibovitz E, Piglansky L, Raiz S, et al. Bacteriologic and clinical efficacy of one day vs. three day intramuscular ceftriaxone for treatment of nonresponsive acute otitis media in children. Pediatr Infect Dis J 2000; 19:1040.
  51. Steele DW, Adam GP, Di M, et al. Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis. Pediatrics 2017; 139.
  52. Kujala T, Alho OP, Luotonen J, et al. Tympanostomy with and without adenoidectomy for the prevention of recurrences of acute otitis media: a randomized controlled trial. Pediatr Infect Dis J 2012; 31:565.
  53. Gonzalez C, Arnold JE, Woody EA, et al. Prevention of recurrent acute otitis media: chemoprophylaxis versus tympanostomy tubes. Laryngoscope 1986; 96:1330.
  54. Paradise JL, Bluestone CD, Colborn DK, et al. Adenoidectomy and adenotonsillectomy for recurrent acute otitis media: parallel randomized clinical trials in children not previously treated with tympanostomy tubes. JAMA 1999; 282:945.
  55. Koivunen P, Uhari M, Luotonen J, et al. Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. BMJ 2004; 328:487.
  56. van den Aardweg MT, Schilder AG, Herkert E, et al. Adenoidectomy for otitis media in children. Cochrane Database Syst Rev 2010; :CD007810.
  57. Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS. Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial. Pediatrics 2005; 116:185.
  58. Paradise JL, Bluestone CD, Rogers KD, et al. Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials. JAMA 1990; 263:2066.
  59. Coyte PC, Croxford R, McIsaac W, et al. The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. N Engl J Med 2001; 344:1188.
  60. Mitchell AA. Xylitol prophylaxis for acute otitis media: tout de suite? Pediatrics 1998; 102:974.
  61. Mäkinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res 1995; 74:1904.
  62. Knuuttila ML, Mäkinen K. Effect of xylitol on the growth and metabolism of Streptococcus mutans. Caries Res 1975; 9:177.
  63. Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev 2016; :CD007095.
  64. Uhari M, Kontiokari T, Niemelä M. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics 1998; 102:879.
  65. Uhari M, Kontiokari T, Koskela M, Niemelä M. Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ 1996; 313:1180.
  66. Hautalahti O, Renko M, Tapiainen T, et al. Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J 2007; 26:423.
  67. Tapiainen T, Luotonen L, Kontiokari T, et al. Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics 2002; 109:E19.
  68. Vernacchio L, Corwin MJ, Vezina RM, et al. Xylitol syrup for the prevention of acute otitis media. Pediatrics 2014; 133:289.
  69. Beachey EH. Bacterial adherence: adhesin-receptor interactions mediating the attachment of bacteria to mucosal surface. J Infect Dis 1981; 143:325.
  70. Zopf D, Roth S. Oligosaccharide anti-infective agents. Lancet 1996; 347:1017.
  71. Lingwood CA. Oligosaccharide receptors for bacteria: a view to a kill. Curr Opin Chem Biol 1998; 2:695.
  72. Idänpään-Heikkilä I, Simon PM, Zopf D, et al. Oligosaccharides interfere with the establishment and progression of experimental pneumococcal pneumonia. J Infect Dis 1997; 176:704.
  73. Ukkonen P, Varis K, Jernfors M, et al. Treatment of acute otitis media with an antiadhesive oligosaccharide: a randomised, double-blind, placebo-controlled trial. Lancet 2000; 356:1398.
  74. Hatakka K, Blomgren K, Pohjavuori S, et al. Treatment of acute otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study. Clin Nutr 2007; 26:314.
  75. Cohen R, Martin E, de La Rocque F, et al. Probiotics and prebiotics in preventing episodes of acute otitis media in high-risk children: a randomized, double-blind, placebo-controlled study. Pediatr Infect Dis J 2013; 32:810.
  76. Roos K, Håkansson EG, Holm S. Effect of recolonisation with "interfering" alpha streptococci on recurrences of acute and secretory otitis media in children: randomised placebo controlled trial. BMJ 2001; 322:210.
  77. Marchisio P, Bianchini S, Galeone C, et al. Use of complementary and alternative medicine in children with recurrent acute otitis media in Italy. Int J Immunopathol Pharmacol 2011; 24:441.
  78. Bukutu C, Deol J, Vohra S. Complementary, holistic, and integrative medicine: therapies for acute otitis media. Pediatr Rev 2008; 29:193.
  79. Gulani A, Sachdev HS. Zinc supplements for preventing otitis media. Cochrane Database Syst Rev 2014; :CD006639.