Comprehensive Assessment of the Global Burden and Risk Determinants of Otitis Media
A systematic review
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Otitis media (OM), a common inflammatory disease of the middle ear mostly affecting kids, is a serious global public health problem. Epidemiological studies indicate that early childhood sees at least one attack in up to 80% of children; the majority of incidents take place between the ages of six months to five years. One of the acute and chronic forms of the disease is Chronic Suppurative Otitis Media (CSOM), which strikes 3.8% of the world population, mostly in low- and middle-income countries. Major risk factors that provoke OM include smoking, weight, breastfeeding, socioeconomic status, genetic factors, and air pollution. Modifiable risk conditions of OM include adenoids, allergies, and craniofacial deformities. Though incidence is geographic, the burden of disease remains highest among underprivileged groups, where overcrowding, unhygienic conditions, and limited access to healthcare drive continuous infection and sequelae
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Al-Ani RM, Al-Ani AM, Al-Ani HA, et al. Prevalence of hearing loss among patients attending the private otolaryngology clinic, Ramadi city, Anbar, Iraq. Egypt J Otolaryngol. 2024;40(1):e71. https://doi.org/10.1186/s43163-024-00636-y
Farraj MA, Ali DH, AlAwa MN. Serous otitis media in children and its impact on hearing. Research Square; 2024. https://doi.org/10.21203/rs.3.rs-4607965/v1
Wang X, Zhu Y, Li J, et al. Proteomic study of middle ear effusion and its clinical application for otitis media with effusion. Infect Drug Resist. 2023;16:5923-5940. https://doi.org/ 10.2147/IDR.S415942
Heward E, Oakley E, Cawthorne R, et al. Exploring the burden of pediatric acute otitis media with discharge in the UK: a qualitative study. BMJ Paediatr Open. 2024;8(1):e003012. https://doi. org/10.1136/bmjpo-2023-003012
Mathema L, Adhikari P, Lamsal M, et al. Chronic otitis media among patients visiting community-based static outreach clinics. JNMA J Nepal Med Assoc. 2023;61(268):923-926. https:// doi.org/10.31729/jnma.8369
Yang J, Zhang H, Li W, et al. Morphological and pathological changes of Eustachian tube mucosa in an animal model of eosinophilic otitis media. Braz J Otorhinolaryngol. 2022;88(6):701–707. https://doi.org/ 10.1016/j.bjorl.2020.09.011
Sirota SB, Xu P, Dutta A, et al. Global, regional, and national burden of upper respiratory infections and otitis media, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Infect Dis. 2025;25(1):36–51.
Hawkings NJ. Attitudes To Upper Respiratory Infections, Antibiotics, And Bacterial Resistance: Managing Common Respiratory Infections And Appropriate Antibiotic Use By The General Population [dissertation]. Cardiff: Cardiff University; 2009.
Khairkar M, Deshmukh N, Patil S, et al. Chronic suppurative otitis media: a comprehensive review of epidemiology, pathogenesis, microbiology, and complications. Cureus. 2023;15(8):e43729.
Onifade A, Abolarinwa OA, Adigun YS, et al. Epidemiology of chronic suppurative otitis media: systematic review to estimate global prevalence. J Epidemiol Glob Health. 2025;15:e55. https://doi.org/10.1007/s44197-025-00396-9
Dân NTT, Minh HP. Risk factors of otitis media with effusion in children: a case-control study. Vietnam J Otorhinolaryngol - Head Neck Surg. 2022;67(58):65–71.
Manyata S, Abdallah T, Mshana SE, et al. Chronic suppurative otitis media: prevalence, bacterial spectrum, and antimicrobial resistance patterns among patients in Tanzania—a cross-sectional study. medRxiv. https:// doi.org/10.1101/2025.06.11.25329461
Vithayathil AA, Zhang W, Alphs H, et al. Air pollution and otitis media among children: systematic review and meta-analysis. Trends Clin Med Sci. 2023:119–127. https://doi.org/10. 30538/psrp-tmcs2023.si-imrv018
Sandhu VP, Singh R, Kaur J, et al. Prevalence of ear disease and associated hearing loss among government rural primary school students in Patiala, Punjab: a cross-sectional survey. Indian J Otolaryngol Head Neck Surg. 2024;76(1):374–379. https://doi.org/10.1007/s12070-023-04165-7
Mori HR, Patel S, Desai M, et al. Incidence of ear, nose, and throat disorders in children: a prospective observational study from a tertiary hospital in Gujarat. Res J Med Sci. 2023;17:186–193.
Toizumi M, Satoh C, Quilty BJ, et al. Effect of pneumococcal conjugate vaccine on prevalence of otitis media with effusion among children in Vietnam. Vaccine. 2022;40(36):5366-5375. https://doi.org/10.1016/j. vaccine.2022.07.047
Restuti RDT, Tamin S, Nugroho DA, Hutauruk SM. Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a comparative cross-sectional study. BMJ Open. 2022;12(9):e065291. https://doi.org/ 10.1136/bmjopen-2022-065291
Mittal R, Robalino G, Gerring R, Chan B, Yan D, Grati M, Liu X‑Z. Immunity genes and susceptibility to otitis media: a comprehensive review. J Genet Genomics. 2014;41(11):567‑581. https://doi.org/ 10.1016/j.jgg.2014.10.003
Lee NK, Santos‑Cortez RLP. Genetics and otitis media. In: Goycoolea MV, Selaimen da Costa S, de Souza C, Paparella MM, eds. Textbook of Otitis Media: The Basics and Beyond. Springer; 2023:91‑107.
Pandey A. Empowering schools for inclusive hearing care: a public health approach to early detection and prevention of hearing loss in Nepal. J Health Soc Welf. 2025;14(1):e20620252.
Dahal R, Shah SP, Mishra S, Baaniya B. Vitamin D deficiency and acute otitis media among children visiting a tertiary care centre in eastern Nepal. Kathmandu Univ Med J. 2023;84(4):363‑366.
Al‑Balasi AK, Omer DM. Prevalence, pattern, and etiology of hearing loss in a tertiary otolaryngology center in central Yemen. Saudi J Otorhinolaryngol Head Neck Surg. 2024;26(3):159‑163. https://doi.org/ 10.4103/sjoh.sjoh_5_24
Shangali A, Kamori D, Massawe W, et al. Aetiology of ear infection and antimicrobial susceptibility pattern among patients attending otorhinolaryngology clinic at a tertiary hospital in Dar es Salaam, Tanzania: a hospital‑based cross‑sectional study. BMJ Open. 2023;13(4):e068359. https://doi.org/10.1136/bmjopen-2022-068359
Hu T, Huang Z, Huang Y, et al. Incidence of acute otitis media in children in the United States before and after introduction of 7‑ and 13‑valent pneumococcal conjugate vaccines during 1998–2018. BMC Infect Dis. 2022;22(1):e294.
Yabo US, Mohammed M, Abubakar A, et al. Otomycosis in patients attending a tertiary health‑care institution in Sokoto, northwestern Nigeria. Indian J Otol. 2024;30(2):86‑89. https://doi.org/10. 4103/indianjotol.indianjotol_130_23
Dubey D, Soni S, Jain A, et al. Evaluation of the antibacterial activity of Coccinia grandis against bacteria isolated from chronic suppurative otitis media infection. J Appl Biol Biotechnol. 2022;11(1):139‑145. https://doi.org/10.7324/JABB.2023.110119
Silva VAR, Pizarro GU, Matas CG, et al. Task force guideline of Brazilian Society of Otology—hearing loss in children—part I—evaluation. Braz J Otorhinolaryngol. 2023;89(1):159‑189. https://doi.org/ 10.1016/j.bjorl.2022.11.002
Akter F, Rahman M, Hossain M, et al. Sociodemographic characteristics and clinical profiles of chronic suppurative otitis media patients at a tertiary care hospital in Bangladesh. Bangladesh J Infect Dis. 2024;11(2):88‑92.
Partycka‑Pietrzyk K, Kruk M, Zielinska M, et al. Audiometric outcomes of ventilation drainage treatment for otitis media with effusion in children: implications for speech development and hearing loss. Med Sci Monit. 2023;29:e941350. https://doi. org/10.12659/MSM.941350
McCarthy H, Smith J, Brown R, et al. A scoping review of ear and hearing health research in Aotearoa New Zealand: a focus on equity. J R Soc. 2025;55(3):611‑632. https://doi.org/ 10.1080/03036758.2024.2435394
Haque AM, Rahman M, Ahmed S, et al. Ear diseases in children presenting at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Saudi J Med Pharm Sci. 2022;8(11):731‑735.
Geng R, Jiang Y, Zhang Y, et al. Current understanding of host genetics of otitis media. Front Genet. 2020;10:e1395. https://doi.org/10. 3389/fgene.2019.01395
Abdel‑Razek MA, Hassan HM, El‑Shamy AM, et al. A review: pharmacological activity and phytochemical profile of Abelmoschus esculentus (2010–2022). RSC Adv. 2023;13(22):15280‑15294. https://doi.org/10.1039/D3RA01367G
Chantzi F, Vardas E, Prokopakis E, et al. IgE sensitization, respiratory allergy symptoms, and heritability independently increase risk of otitis media with effusion. Allergy. 2006;61(3):332‑336. https://doi.org /10.1111/j.1398-9995.2006.00971.x
Wald ER, Guerra N, Byers C. Frequency and severity of infections in day care. J Pediatr. 1988;112(4):540‑546. https://doi.org /10.1016/S0022-3476(88)80164-1
Sambo U, Sule B. Impact of climate change on food security in Northern Nigeria. Green Low-Carbon Econ. 2024;2(1):49-61. https://doi.org/10. 47852/bonviewGLCE3202560
Assiri K, Hudise J, Obeid A. Risk factors for chronic and recurrent otitis media in children: a review article. Indian J Otolaryngol Head Neck Surg. 2024;76(1):1464‑1469. https:// doi.org/10.1007/s12070-023-04256-5
Elemraid M, Mackenzie IJ, Fraser WD, et al. Nutritional factors associated with chronic suppurative otitis media in Yemeni children. Eur J Clin Nutr. 2011;65(8):895‑902. https://doi.org/10.1038/ejcn.2011.58
Koshy E, Watt H, Curcin V, Bottle A, Sharland M, Saxena S. Tonsillectomy among children with low baseline acute throat infection consultation rates in UK general practices: a cohort study. BMJ Open. 2015;5(2):e006686. https://doi.org/10.1136/bmjopen-2014-006686
Gunasekera H. The wicked problem of otitis media: summary of recent systematic reviews on otitis media with effusion. Paediat Respirat Rev. 2025;45:10-14. https://doi.org/10. 1016/j.prrv.2025.04.008
Nichols E, Steinmetz JD, Vollset SE, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105‑e125. https:// doi.org/10.1016/S2468-2667(21)00249-8
Abdel‑Razek O, Khalil M, El‑Sherbiny M, et al. Surfactant proteins and innate immunity of otitis media. Innate Immun. 2022;28(7‑8):213‑223. https:// doi.org/10.1177/17534259221123309
Yang K, Liu Z. Comparison of 1000 Hz‑, 226 Hz‑probe tone tympanometry and MRI in evaluating function of middle ear in infants. Int J Pediatr Otorhinolaryngol. 2020;136:e110135. https://doi.org/10.1016/j.ijporl.2020.110135
Aslan S, Yilmaz O, Aydin M, et al. Relation between passive cigarette smoking in children and respiratory infections: evaluation of urine cotinine/creatinine. Med Bull Haseki. 2022;60(3):254-262. https://doi.org/ 10.4274/haseki.galenos.2022.8045
Lechien JR. Pediatric laryngopharyngeal reflux: an evidence‑based review. Children (Basel). 2023;10(3):e583. https://doi. org/10.3390/children10030583
Alaraifi AK, Almutairi B, Alharbi A, et al. Predictors of tympanostomy tube extrusion time in otitis media with effusion. Saudi Med J. 2022;43(7):e730. https://doi.org/10. 15537/smj.2022.43.7.20220323
Christensen N, Bruun T, Sørensen TI, et al. Breastfeeding and infections in early childhood: a cohort study. Pediatrics. 2020;146(5):e20191892. https://doi.org/10.1542/peds.2019-1892
Sambo UG, Musa AM, Ahmed A, et al. Chronic suppurative otitis media in the National Ear Care Centre, Kaduna, Nigeria. Kanem J Med Sci. 2021;15(2):118‑123.
Kleinjung T, Londero A. Conductive and sensorineural hearing loss. In: Schlee W, Langguth B, De Ridder D, Vanneste S, Kleinjung T, Møller AR. eds. Textbook of Tinnitus. Springer; 2024:385‑398.
Çakıcı K, Gökdoğan O. Otitis media in immunodeficient children. Mugla Sitki Kocman Univ Tip Derg. 2025;12(1):61‑66. https://doi.org/10. 47572/muskutd.1554390
James R, Smith A, Brown T, et al. Long‑term outcomes of childhood otitis media and hearing loss: a systematic review. Speech Lang Hear. 2025;28(1):e2420455. https://doi.org/ 10.1080/2050571X.2024.2420455
Gaber YA, Al‑Sanabani M, Al‑Aghbari N, et al. Health care in Yemeni children during the war. Prim Health Care Res Dev. 2022;23:e55. https://doi.org/10.1017/S1463423622000421
Fuji N, Yamanaka N, Hotomi M, et al. Eighteen‑year longitudinal study of uncomplicated and complex acute otitis media during the pneumococcal conjugate vaccine era, 2006–2023. J Infect Dis. 2025;232;(2):417-429. https://doi.org/10.1093/infdis/jiaf154
Swain SK, Sahu MC, Padhy RN, et al. Microbiology of chronic otitis media—a review. DY Patil J Health Sci. 2022;10(2):67‑72. https://doi.org/ 10.4103/DYPJ.DYPJ_55_22
Rashwan N, Abdelaziz M, El‑Sayed A, et al. Macrolide resistance of Streptococcus pneumoniae in patients with otitis media. Bull Pharm Sci Assiut. 2013;36(1):1‑9.
Bizaki‑Vallaskangas A, Rautiainen M, Jero J, et al. Genome‑wide association study indicates novel associations of annexin A13 to secretory and GAS2L2 with mucous otitis media. Sci Rep. 2024;14(1):e18344. https://doi.org/ 10.1038/s41598-024-68781-1
Heward E, Bowman J, Haggard M, et al. Risk factors for chronic suppurative otitis media in children: systematic review and meta‑analysis. Clin Otolaryngol. 2024;49(1):62‑73.
Udoh E, Etim A, Akpan E, et al. Morbidity pattern of under‑fives with moderate acute malnutrition in southern Nigeria. Ibom Med J. 2024;17(1):68‑74.
Dermawan A, Setiawati L, Pradono J, et al. Determinants of acute otitis media in children: a case‑control study in West Java, Indonesia. Medicina (Kaunas). 2025;61(2):e197. https:// doi.org/10.3390/medicina61020197
Piperno S, Marchisio P, Bianchini S, et al. Preventing unnecessary tympanostomy tube placement in children: a 5‑year update. Int J Pediatr Otorhinolaryngol. 2025;191:e112250. https://doi.org/10.1016/j.ijporl.2025.112250
Adekanye A, Bassey A, Inyang E, et al. Risk factors for otitis media with effusion in preschool and school children in Calabar Municipality. Niger J Clin Pract. 2024;27(4):435‑441.
Khan TM, Saeed A, Iqbal M, et al. Risk factors of acute otitis media among infants in a tertiary care hospital in Rawalpindi. Int J Otorhinolaryngol Head Neck Surg. 2022;8(9):711‑715. https://dx.doi.org/10.18203/issn.2454-5929.ijohns20222161
Wijayanti SPM, Hartono H, Nugroho S, et al. Risk factors for acute otitis media in primary school children: a case‑control study in Central Java, Indonesia. J Public Health Res. 2021;10(1):e1909. https://doi.org/ 10.4081/jphr.2021.1909
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