Definition of Recurrent Otitis Media
Recurrent acute otitis media (AOM) is defined as 3 or more well-documented episodes of AOM within 6 months, OR 4 or more episodes within 12 months, with at least 1 episode occurring in the past 6 months. 1, 2
Key Diagnostic Criteria
The episodes must meet specific requirements to qualify as recurrent AOM:
- Each episode must be a separate, well-documented acute infection with complete resolution between episodes—not continuous symptoms from a single prolonged infection 1, 2, 3
- Each episode should demonstrate the hallmark features of AOM: rapid onset of signs and symptoms of middle ear inflammation, including moderate-to-severe bulging of the tympanic membrane, recent onset ear pain, or intense erythema 1
- The definition applies primarily to the pediatric population, as this condition predominantly affects children 2
Critical Distinction from Other Ear Conditions
Do not confuse recurrent AOM with otitis media with effusion (OME), which is fluid in the middle ear without signs or symptoms of acute infection 1, 4. This distinction is clinically crucial:
- OME lacks the acute inflammatory signs (fever, severe ear pain, bulging tympanic membrane) that characterize AOM 1
- Chronic OME is defined as middle ear effusion persisting ≥3 months 1
- Misdiagnosing OME as recurrent AOM leads to inappropriate antibiotic overuse 4
Clinical Significance and Epidemiology
Understanding this definition has important management implications:
- Approximately 50% of children under age 2 treated for AOM will experience recurrence within 6 months, making this a common clinical scenario 2
- The definition threshold (3 episodes in 6 months or 4 in 12 months) identifies children who may benefit from interventions beyond standard treatment, such as tympanostomy tube placement 2
- About 20-30% of the pediatric population experiences recurrent AOM during the first several years of life 4
Documentation Requirements
For accurate diagnosis, each episode should be documented with: