What is the risk of developing otitis media (middle ear infection) after contracting influenza (flu) or a common cold (upper respiratory tract infection)?

From the Guidelines

The risk of developing otitis media (middle ear infection) after contracting influenza (flu) or a common cold (upper respiratory tract infection) is significant, especially in young children.

Causes and Risk Factors

• Otitis media (OM) can be caused by both viral and bacterial infections, with viruses often ascending through the Eustachian tube to the middle ear and paving the way for bacterial otopathogens 1.
• The Eustachian tube dysfunction, often associated with upper respiratory tract infections, can lead to the development of OM 1.
• Young children are at a higher risk due to their underdeveloped Eustachian tubes, which are too short, floppy, and horizontal, making them more prone to OM 1.

Types of Otitis Media

• Acute otitis media (AOM) is characterized by the presence of fluid in the middle ear, along with signs and symptoms of an acute infection, such as ear pain and fever 1.
• Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without signs or symptoms of an acute infection, often leading to conductive hearing loss 1.

Incidence and Prevalence

• OM is one of the most common diseases in young children worldwide, with 80% of children having had one or more episodes of OME by 10 years of age 1.
• The rate of AOM and OME following upper respiratory tract infection (URTI) was 37% and 24%, respectively, in children at the peak age of incidence (6-47 months) 1.

Prevention and Management

• Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent, or recurrent infections 1.
• Watchful waiting is often recommended for OME, with ventilation tubes primarily used for children with chronic effusions and hearing loss, developmental delays, or learning difficulties 1.

From the Research

Risk of Developing Otitis Media

The risk of developing otitis media (middle ear infection) after contracting influenza (flu) or a common cold (upper respiratory tract infection) is supported by several studies.

• The pathogenesis of acute otitis media involves a complex interplay between viruses, bacteria, and the host's inflammatory response 2.
• Viral infection of the upper respiratory mucosa initiates the whole cascade of events that finally leads to the development of acute otitis media as a complication 2.
• Respiratory viruses, including influenza, can be found in the middle-ear fluid either alone or together with bacteria, and recent studies indicate that at least some viruses actively invade the middle ear 2, 3.
• Viruses appear to enhance the inflammatory process in the middle ear, and they may significantly impair the resolution of otitis media 2, 3.

Role of Influenza and Common Cold

• Influenza infection is associated with a significant number of acute otitis media cases, and influenza viruses are among the most frequently found respiratory viruses in the middle ear fluid during an acute episode of AOM 4.
• The common cold, or upper respiratory tract infection, is usually considered the precursor to acute otitis media, and the risk of developing AOM is increased after contracting a viral upper respiratory tract infection 2, 3.
• The administration of influenza vaccine may have a favorable impact on the incidence and course of AOM, as it can reduce the risk of influenza infection, which predisposes to pneumococcal infection 4.

Prevention and Treatment

• Prevention of otitis media is possible by use of chemoprophylaxis or vaccines, including pneumococcal conjugate vaccine and influenza vaccine 5, 4.
• The use of vaccines, such as pneumococcal conjugate vaccine and influenza vaccine, may reduce the incidence of AOM, although the extent of their effectiveness is still being studied 4.