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Published on: January 26, 2019

RSV-associated acute otitis media in children under five years old: a systematic review and meta-analysis

Rosa Hamilton-Smith, Sohail Ferdous, Daira Trusinska

    Journal of Global Health
    |June 26, 2026
    PubMed

    Insights

    Respiratory syncytial virus (RSV) frequently complicates acute otitis media (AOM) in young children, with over 27% of RSV infections leading to AOM. Bacterial co-infections and high viral load are key risk factors for RSV-associated AOM.

    Area of Science:

    • Pediatric Infectious Diseases
    • Virology
    • Epidemiology

    Background:

    • Respiratory syncytial virus (RSV) is a major cause of infant respiratory illness.
    • RSV significantly contributes to the development of acute otitis media (AOM).

    Purpose of the Study:

    • To synthesize existing evidence on RSV-associated AOM.
    • To inform future research aimed at reducing the morbidity of RSV-associated AOM.

    Main Methods:

    • A systematic review and meta-analysis was conducted in April 2025.
    • Searched Embase, MEDLINE, and Global Health databases for studies on RSV-associated AOM in children aged 0-60 months.
    • Extracted data on RSV complication rates, RSV detection in AOM samples, and risk factors for AOM in RSV-positive children.

    Main Results:

    • Approximately 27.7% of RSV infections were complicated by AOM.
    • RSV was detected in 23.6% of AOM samples, with higher rates in nasopharyngeal (22.2%) than middle ear fluid (18.8%) samples.
    • Bacterial co-infections were found in 70.1% of RSV-positive middle ear fluid samples; risk factors included high viral load, S. pneumoniae co-infection, age (3-12 months), and fever.

    Conclusions:

    • RSV is a significant viral factor in AOM development.
    • Heterogeneity across studies limits current findings' generalizability.
    • Standardized prospective studies are needed to improve risk stratification and intervention evaluation for RSV-associated AOM.
    Abstract

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