Otitis media prevention: non-vaccine prophylaxis

Preventing recurrent acute otitis media (AOM) is a goal of child health care. The objective is to reduce the frequency of pain and fever, shorten the duration of hearing loss, reduce the costs of physician visits, surgery and drugs, reduce parent anxiety, and prevent long term sequelae. Preventive approaches include understanding individual and familial risk factors, avoidance of environmental risk factors, antibiotic drug prophylaxis, polyvalent pneumococcal vaccination, myringotomy with tympanostomy tubes, and adenoidectomy. Earlier and more aggressive treatment can be provided to infants at increased risk. Antibiotic prophylaxis is challenged by a relatively small benefit and emerging resistant bacteria. Tympanostomy tubes are beneficial in chronic otitis media with effusion (OME), but of less value in recurrent AOM absent chronic OME. Adenoidectomy after tympanostomy tube failure is supported by at least one clinical trial.