Etiology

The etiology of otitis media (OM) is multifactorial. Anatomic, environmental and constitutional factors play a roll in the development of OM. Children are particulary susceptible to the disease for a number of reasons. Some of the factors shown to increase the risk of OM in childen, are:

• Genetic factors which affect the structure and function of the eustachian tubes:
  • craniofacial defects especially cleft palate
  • Down syndrome
  • Native Americans and Inuits appear to have increased incidence of acute otitis media.
• Environment - season, affected siblings, crowding, daycare attendance, low socioeconomic status and parental smoking
• Feeding - breast milk substitutes, bottle feeding, supine feeding, pacifier use
• Immune status:
  • Immature or compromised immune system
  • recent upper respiratory infection
    • viral or bacterial antigen is detected in about 25% of otitis media effusion aspirates
    • evidence of pathologic bacteria are detectable in about 50% of AOM aspirate
  • allergic rhinitis
  • asthma
• Age - The incidence of OM varies by classification
  • Acute otitis media (AOM) peaks between 6-11 months and declines between 18-20 months of age.
  • Otitis media with effusion (OME) incidence - 48% at 6 months, 79% at 1 year, 91% at 2 years.
  • Neonates and infants have shorter, horizontal and undeveloped eustachian tubes that predispose to reflux of naso-pharyngeal fluid into the eustachian tube
• Gender - Males have a slightly higher prevalence of OM than females

Environment exposure and feeding are two factors that may be altered by parenting. Nurses may be able to influence the course of the OM through effective parental education.

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