Lack of seasonal variability for recurrent otitis media in very young children

Effective strategies are available to prevent recurrent otitis media (ROM). Because epidemiologic studies have demonstrated marked seasonal variation in acute otitis media (AOM), clinical guidelines often recommend cessation of prophylactic measures during the summer. Unfortunately, those studies did not separately assess seasonal variation in children with ROM, the group most likely to benefit from preventive measures.

The charts of 648 children who had at least one diagnosis of AOM were reviewed to count AOM rates by calendar month and age. Children with at least three infections in a 6-month period were assigned to a ROM group and analyzed separately. Seasonal variability was statistically assessed using the ranked-sums method of Hewitt.

The criterion for ROM was met by 176 children (27%), who had 1096 episodes of AOM and accounted for 52% of all infections. In the ROM group, the monthly infection rate remained above 10% for the first 2 years of life. There was no seasonal variation in the ROM group under 1 year of age. The recurrence risk for those who met the ROM criterion was very high: first month, 32%; second month, 30%; third month, 22%; fourth month, 20%.

The youngest otitis-prone children show a high rate of infection in the summer months and a very high rate of recurrence. In these children, decisions about beginning or continuing preventive measures should not be influenced by the season of the year.