By age 3, 60% of children in a US cohort followed from 2006 to 2016 had at least one acute otitis media episode confirmed by tympanocentesis, and 24% had three or more (Kaur et al., Pediatrics 2017). Worldwide, the Global Burden of Disease Study counted 391 million new otitis media episodes in 2021 (GBD 2021 Collaborators, Lancet Infectious Diseases 2025). In US clinics, 84.4% of 140,579 pediatric ear infection visits ended with an immediate antibiotic (Jenkins et al., JPIDS 2025), and childhood acute otitis media was estimated to cost $4.3 billion a year (Hu et al., BMC Health Services Research 2023). We aggregated data from the CDC National Center for Health Statistics, the AAO-HNSF clinical practice guidelines, Cochrane reviews, the Global Burden of Disease Study, the World Health Organization, and more than two dozen cohort, trial, and claims studies. Because middle ear fluid is a frequent cause of temporary hearing loss in early childhood, this roundup sits next to our data on toddler audiometry screening rates and pediatric hearing screening and EHDI follow-up.
TL;DR
- 60% of children had at least one acute otitis media (AOM) episode by age 3, and 23% by age 1, in a 2006-2016 US cohort (Kaur et al., Pediatrics 2017).
- The 1980s Greater Boston cohort reported 83% by age 3 and 62% by age 1 (Teele et al., Journal of Infectious Diseases 1989).
- AOM incidence in US children under 2 fell from 1,170.1 to 768.8 episodes per 1,000 person-years between 1998-1999 and 2014-2018 (Hu et al., BMC Infectious Diseases 2022).
- Otitis media visits in children under 5 dropped 41%, from 78 to 46 per 100 children, across the pneumococcal conjugate vaccine era (Wasserman et al., Emerging Infectious Diseases 2021).
- 84.4% of pediatric AOM visits got an immediate antibiotic and 15.6% were managed with watchful waiting in 2018-2023 (Jenkins et al., JPIDS 2025).
- 75% of antibiotic courses for children aged 2 and older ran 10 days (Katz et al., JPIDS 2024).
- 699,000 tube insertions were performed on US children under 15 in 2010 (CDC NCHS, National Health Statistics Reports No. 102, 2017).
- In a randomized trial, tubes did not significantly reduce recurrent AOM: 1.48 vs 1.56 episodes per child-year, P = 0.66 (Hoberman et al., NEJM 2021).
- About 90% of children have otitis media with effusion before school age, with an average hearing loss of 28 dB (AAO-HNSF Clinical Practice Guideline 2016).
- Chronic suppurative otitis media affects an estimated 3.8% of the world population, about 297 million people (Onifade et al., Journal of Epidemiology and Global Health 2025).
- Childhood AOM costs the US an estimated $4.3 billion a year across 15.8 million cases (Hu et al., BMC Health Services Research 2023).
1. How Many Children Get an Ear Infection by Age 1 and Age 3
The two best-known US birth cohorts disagree by more than 20 percentage points, and the gap is mostly about how the disease was counted. The 2006-2016 cohort confirmed every diagnosis by tympanocentesis and middle ear fluid culture and found that 60% of children had at least one AOM episode by age 3 (Kaur et al., Pediatrics 2017). The Greater Boston cohort of the 1980s, diagnosed clinically, put the figure at 83%.
The authors of the newer study attribute the decline most prominently to stricter diagnostic criteria, alongside vaccine introduction. That matters for anyone quoting a headline number: the widely repeated “five out of six children” figure from NIDCD tracks the older cohort, not the newer one. Risk is also unevenly distributed. Day care attendance carried an odds ratio of 2.78 (95% CI 2.19-3.52) for AOM in the newer cohort, and 27.8% of boys had an episode in the first year against 17.4% of girls.
| Metric | Value | Source |
|---|---|---|
| Children with at least 1 AOM episode by age 1 (cohort of 615, 2006-2016) | 23% | Kaur et al., Pediatrics 2017 |
| Children with at least 1 AOM episode by age 3 (same cohort) | 60% | Kaur et al., Pediatrics 2017 |
| Children with at least 3 AOM episodes by age 3 (same cohort) | 24% | Kaur et al., Pediatrics 2017 |
| Children with at least 1 AOM episode by age 1 (Greater Boston cohort) | 62% | Teele et al., Journal of Infectious Diseases 1989 |
| Children with at least 1 AOM episode by age 3 (Greater Boston cohort) | 83% | Teele et al., Journal of Infectious Diseases 1989 |
| Children with at least 3 AOM episodes by age 3 (Greater Boston cohort) | 46% | Teele et al., Journal of Infectious Diseases 1989 |
| Children with at least one ear infection by their third birthday | 5 out of 6 | NIDCD, Ear Infections in Children (page updated 2022) |
| US children under 18 diagnosed with AOM in a year (2009 survey data) | 8.7 million (10.7%) | Ahmed et al., Laryngoscope 2014 |
Most recent available data: the tympanocentesis-confirmed cohort closed in June 2016 (Kaur et al., Pediatrics 2017), and no newer US birth cohort with comparable confirmation has been published. The NIDCD ear infections page was last updated in March 2022.
2. Annual Incidence, Office Visits, and the Pneumococcal Vaccine Effect
Ear infection rates in the youngest children fell by about a third over two decades of pneumococcal conjugate vaccination. In commercially insured US children under 2, AOM incidence dropped from 1,170.1 to 768.8 episodes per 1,000 person-years between 1998-1999 and 2014-2018 (a 34% decline by our calculation: 401.3 / 1,170.1), and recurrent AOM in the same age group fell from 426.6 to 206.1 per 1,000 person-years (Hu et al., BMC Infectious Diseases 2022).
Population trends and trial results do not line up neatly, and that is the interesting part. Ambulatory visits fell 41%, yet the randomized trials pooled by Cochrane found that PCV7 reduced all-cause AOM by only 6% in low-risk infants. The difference points to everything else that changed at the same time: the authors of the visit model list changes in otitis media coding and antimicrobial prescribing patterns as possible confounders, and the cohort authors in section 1 point to stricter diagnostic criteria. Even after the decline, utilization at age 1 stood at 503.9 AOM-related contacts per 1,000 person-years, about one contact per year for every two children.
| Metric | Value | Source |
|---|---|---|
| AOM incidence, children under 2, 1998-1999 | 1,170.1 per 1,000 person-years | Hu et al., BMC Infectious Diseases 2022 |
| AOM incidence, children under 2, 2014-2018 | 768.8 per 1,000 person-years | Hu et al., BMC Infectious Diseases 2022 |
| AOM incidence, children aged 2-4, 1998-1999 vs 2014-2018 | 547.4 vs 410.3 per 1,000 person-years | Hu et al., BMC Infectious Diseases 2022 |
| Otitis media visits per 100 children under 5, pre-vaccine vs PCV13 era | 78 vs 46 (41% lower) | Wasserman et al., Emerging Infectious Diseases 2021 |
| Otitis media health care visits averted by PCV7 and PCV13 over 20 years | 97 million | Wasserman et al., Emerging Infectious Diseases 2021 |
| AOM-related health care utilization at age 1, 2008-2014 | 503.9 per 1,000 person-years | Tong et al., BMC Health Services Research 2018 |
| Otitis media visit rate, children aged 6 or younger, 2010 vs 2011 | 1.00 vs 0.81 per child-year | Marom et al., JAMA Pediatrics 2014 |
| All-cause AOM reduction with PCV7 in low-risk infants (1 trial, 37,868 children) | 6% relative risk reduction (95% CI 4% to 9%) | Cochrane Review, de Sévaux et al. 2020 |
One outlier in the same claims data: AOM-related complications (tympanic membrane perforation, otorrhea, mastoiditis combined) rose in children under 2, from 2.6 to 7.4 per 1,000 person-years, even as infections fell (Hu et al., BMC Infectious Diseases 2022). The vaccine-era visit model is in Wasserman et al., Emerging Infectious Diseases 2021. Most recent available data: claims series end in 2018 and the visit model assumes 2014-2019 rates equal 2013 rates.
3. Antibiotic Prescribing and Watchful Waiting
Current CDC guidance, which defers to the American Academy of Pediatrics guideline for regimens, describes watchful waiting as appropriate for some mild cases through shared decision-making. Practice has barely moved toward it. In the largest recent US dataset, 84.4% of pediatric AOM visits ended with an immediate antibiotic and only 15.6% used watchful waiting (Jenkins et al., JPIDS 2025). Among the watchful waiting visits, 56% involved no antibiotic at all and 44% a delayed prescription.
The outcome data explain why stewardship researchers keep pressing the point. A new antibiotic was prescribed 3 to 30 days after the visit for 6% of the watchful waiting group and 7% of the immediate antibiotic group, and all 3 mastoiditis cases (0.002% of visits) occurred in children treated immediately. The authors caution that they could not directly compare the groups because illness severity data were missing, so the comparison is descriptive.
Duration is the second variable. A simulation built on 86 studies estimated 107 million antibiotic days of therapy a year for AOM in US children, and that following AAP guidance could cut that total by 54% (Morin et al., Children 2025). The trial evidence is age-specific, though: in children aged 6 to 23 months, clinical failure was 34% with a 5-day course against 16% with a 10-day course.
| Metric | Value | Source |
|---|---|---|
| Pediatric AOM visits with an immediate antibiotic, 2018-2023 | 84.4% | Jenkins et al., JPIDS 2025 |
| Pediatric AOM visits managed with watchful waiting, 2018-2023 | 15.6% | Jenkins et al., JPIDS 2025 |
| AOM episodes treated with antibiotics within 3 days, 2005-2019 claims | 77.8% | Smolinski et al., Pediatrics 2022 |
| Antibiotic courses lasting 10 days, children aged 2-17, 2019-2022 | 75% | Katz et al., JPIDS 2024 |
| Amoxicillin share of AOM antibiotic prescriptions (1,051,007 children) | 56.6% | Frost et al., Journal of Pediatrics 2022 |
| Antibiotic days of therapy prescribed for AOM per year, US (simulated) | 107 million | Morin et al., Children 2025 |
| Children treated to prevent one case of pain at 2-3 days vs treated per one adverse event | NNTB 20 vs NNTH 14 | Cochrane Review, Venekamp et al. 2023 |
| Clinical failure, 5-day vs 10-day amoxicillin-clavulanate, ages 6-23 months | 34% vs 16% | Hoberman et al., NEJM 2016 |
The Cochrane pooled analysis found no significant difference in pain at 24 hours between antibiotics and placebo (RR 0.89, 95% CI 0.78 to 1.01) across 5 trials and 1,394 children. The CDC pediatric outpatient guidance states that 4-10% of children with AOM treated with antibiotics experience adverse effects (CDC, Outpatient Clinical Care for Pediatric Populations 2024). The watchful waiting dataset is published open access in Jenkins et al., JPIDS 2025.
4. Tympanostomy Tube Surgery Volumes
Tube insertion is described by the AAO-HNSF as the most common ambulatory surgery performed on US children, yet the last national procedure count is 16 years old. That survey recorded 699,000 myringotomy with tube insertion procedures in children under 15 in 2010, up from 667,000 in 2006. Set against the 2,916,000 ambulatory procedures counted for that age group, that is about 24% (699,000 / 2,916,000).
The newer evidence complicates the case for surgery in recurrent infection. In the NEJM trial of 250 children aged 6 to 35 months, tubes did not significantly lower the infection rate over 2 years, and 45% of the children assigned to medical management (54 of 121) eventually received tubes anyway. Children with tubes spent fewer days on systemic antimicrobials (8.76 vs 12.92 days per year) but more days with tube otorrhea (7.96 vs 2.83).
Access is the other story. In a 454,924-child pediatric network cohort, non-Hispanic Black children with otitis media had an adjusted hazard ratio of 0.32 for tube insertion relative to non-Hispanic White children, and Hispanic children 0.40 (Dedhia et al., Laryngoscope 2025).
| Metric | Value | Source |
|---|---|---|
| Tube insertions in US children under 15, 2006 | 667,000 | CDC NCHS, National Health Statistics Reports No. 11, 2009 |
| Tube insertions in US children under 15, 2010 | 699,000 | CDC NCHS, National Health Statistics Reports No. 102, 2017 |
| US children who have ever had tubes placed, 2014 | 8.6% (6.26 million) | Bhattacharyya and Shay, Otolaryngology-Head and Neck Surgery 2020 |
| Children with otitis media who had surgery, 2009-2022 network cohort | 17.2% | Dedhia et al., Laryngoscope 2025 |
| Repeat procedure after an initial tube-only surgery | 20.7% | Dedhia et al., Laryngoscope 2025 |
| AOM episodes per child-year over 2 years, tubes vs medical management | 1.48 vs 1.56 (P = 0.66) | Hoberman et al., NEJM 2021 |
| Danish children aged 0-12 with at least one tube insertion, 2019 vs 2023 | 3.11% vs 3.67% | Lüscher et al., Clinical Epidemiology 2026 |
| Tube placement among children with otitis media, with vs without housing and economic insecurity | 2.93% vs 6.15% | Epstein et al., International Journal of Pediatric Otorhinolaryngology 2025 |
Most recent available data: the national procedure count uses 2010 survey data (CDC NCHS, National Health Statistics Reports No. 102) and the prevalence figure comes from the 2014 National Health Interview Survey. The network cohort (Dedhia et al., Laryngoscope 2025) shows tube-only rates dropping to about 10% of children with otitis media in 2020 before rebounding in 2021, and the randomized trial is in Hoberman et al., NEJM 2021.
5. Otitis Media with Effusion, Hearing Loss, and Speech-Language Effects
Fluid behind the eardrum without acute infection is close to universal in early childhood: about 90% of children have otitis media with effusion (OME) before school age (AAO-HNSF Clinical Practice Guideline: Otitis Media with Effusion 2016). The hearing effect is measurable, but the long-term developmental evidence is weaker than that prevalence might suggest.
The pattern across studies is consistent. Prospective studies pooled in a meta-analysis show small negative associations between OME and early language, and hearing explained only 3%-9% of the variance in language through 2 years of age (Roberts et al., Pediatrics 2004). When 429 children with persistent effusion were randomized to prompt or delayed tubes, none of 48 developmental measures differed significantly at ages 9 to 11. Tubes clear the fluid faster, but the Cochrane review found normal hearing at 12 months in 54% with tubes and 51% without, on very low certainty evidence.
That is the context for reading referral data in our roundups on pediatric speech delay and early intervention and auditory brainstem response (ABR) testing: hearing loss from effusion is common in the same age band those roundups cover, and half of it resolves within 3 months.
| Metric | Value | Source |
|---|---|---|
| Children who have OME before school age | About 90% | AAO-HNSF Clinical Practice Guideline: OME 2016 |
| OME episodes that persist for 3 months or longer | At least 25% | AAO-HNSF Clinical Practice Guideline: OME 2016 |
| Average hearing loss with OME; share exceeding 35 dB HL | 28 dB; about 20% | AAO-HNSF Clinical Practice Guideline: OME 2016 |
| Range of average OME-related hearing loss across 12 studies | 18-35 dB HL | Cai et al., International Journal of Audiology 2017 |
| OME-related hearing loss resolved by 3 and by 6 months | 50% and 60% | Paing et al., Archives of Disease in Childhood 2024 |
| Association of OME with receptive and expressive language (standard differences) | 0.24 and 0.25 | Roberts et al., Pediatrics 2004 |
| Developmental measures differing at ages 9-11, early vs delayed tubes (391 children) | 0 of 48 | Paradise et al., NEJM 2007 |
| Persistent OME at 6 months, tubes vs no treatment (1 study, 54 children) | 20.4% vs 68.0% | Cochrane Review, MacKeith et al. 2023 |
Prevalence is much higher in some groups: the same guideline reports OME in 60% to 85% of children with Down syndrome or cleft palate, and fluid in one or both ears in about 1 in 8 children screened at ages 5 to 6. Sources: AAO-HNSF OME guideline release and fact sheet and Cochrane Review of ventilation tubes for OME, 2023. Most recent available data: the guideline dates from 2016 and the developmental trial from 2007.
6. Global Burden and Chronic Suppurative Otitis Media
Otitis media almost never kills, and that is exactly why it is easy to under-count. The Global Burden of Disease Study attributes just 536 deaths to it in 2021, against 391 million new episodes and 2.48 million disability-adjusted life years (GBD 2021 Collaborators, Lancet Infectious Diseases 2025). The burden is disability, not death: 2.45 million of those 2.48 million DALYs are years lived with disability.
Incidence rates have fallen 16.3% since 1990, but the absolute number of episodes still grew, from 316 million to 391 million. The highest regional rate was in western sub-Saharan Africa, at 8,665.1 per 100,000. Chronic suppurative otitis media (CSOM), the persistently draining ear, shows the sharpest inequality: a 2025 systematic review of 29 community studies put global prevalence at 3.8% and found 85% of cases in low- and middle-income countries.
| Metric | Value | Source |
|---|---|---|
| New otitis media episodes worldwide, 2021 | 391 million (95% UI 292 to 525) | GBD 2021 Collaborators, Lancet Infectious Diseases 2025 |
| Change in global otitis media incidence rate, 1990-2021 | Down 16.3% (to 4,958.9 per 100,000) | GBD 2021 Collaborators, Lancet Infectious Diseases 2025 |
| Deaths attributed to otitis media worldwide, 2021 | 536 (95% UI 217 to 1,240) | GBD 2021 Collaborators, Lancet Infectious Diseases 2025 |
| Incident otitis media cases in children aged 0-14, 1990 vs 2021 | 256 million vs 297 million | Dong et al., European Archives of Oto-Rhino-Laryngology 2025 |
| Global prevalence of chronic suppurative otitis media | 3.8% (95% CI 3.1-4.5%), about 297 million people | Onifade et al., Journal of Epidemiology and Global Health 2025 |
| CSOM cases associated with disabling hearing loss | 62% | Onifade et al., Journal of Epidemiology and Global Health 2025 |
| Children under 15 with otitis media-induced hearing loss, 2021 | 34.71 million | Jin et al., European Archives of Oto-Rhino-Laryngology 2025 |
| Share of hearing loss in children under 5 attributed to otitis media, 2021 | 68.7% | Guo et al., BMC Public Health 2024 |
Two figures of 297 million appear in this table by coincidence: one is CSOM prevalence at all ages, the other is new otitis media episodes in children. Older estimates sit far apart. The WHO 2004 report on CSOM gave a range of 65-330 million people with draining ears, 60% of them with significant hearing impairment, and Monasta et al., PLoS One 2012 estimated 709 million AOM cases a year for 2005, 51% of them in children under five. The current WHO fact sheet states that nearly 60% of hearing loss in children is due to avoidable causes (WHO, Deafness and hearing loss fact sheet 2026). The 2021 estimates are in GBD 2021, Lancet Infectious Diseases and the CSOM review in Onifade et al. 2025.
7. Health Care Costs
A single ear infection is cheap, and the total is not. At a mean of $329 per commercially insured episode, the roughly 15.8 million annual cases in US children add up to $4.3 billion a year, of which $2.0 billion is spent on children under 2 (Hu et al., BMC Health Services Research 2023). Outpatient visits make up about half of the per-episode cost.
Recurrence is what moves the number. A recurrent AOM episode cost $487 against $226 for a simple one in the national estimates, and 12.4% of recurrent commercial episodes involved a surgical procedure, against 3.8% of all commercial episodes. Cost estimates from different methods land in the same range: a survey-based approach put the incremental cost of pediatric AOM at $2.88 billion for 2009, and the AAO-HNSF guideline places direct costs of otitis media (acute and with effusion) at $3 billion to $5 billion a year.
| Metric | Value | Source |
|---|---|---|
| Annual cost of AOM in US children under 18 (15.8 million cases, 2019 dollars) | $4.3 billion | Hu et al., BMC Health Services Research 2023 |
| Mean cost per AOM episode, commercial vs Medicaid | $329 vs $184 | Hu et al., BMC Health Services Research 2023 |
| Mean cost per episode, recurrent vs simple AOM | $487 vs $226 | Hu et al., BMC Health Services Research 2023 |
| Incremental annual health care expense of pediatric AOM, 2009 | $2.88 billion | Ahmed et al., Laryngoscope 2014 |
| Added outpatient cost per child with AOM per year, 2009 | $314 | Ahmed et al., Laryngoscope 2014 |
| Mean cost per AOM episode by setting, 2013-2014 | $199.0 office; $329.6 emergency or urgent care; $1,592.9 hospital | Tong et al., BMC Health Services Research 2018 |
| Annual cost of otitis media with effusion (2.2 million diagnosed episodes) | $4.0 billion | AAO-HNSF Clinical Practice Guideline: OME 2016 |
Most recent available data: the national cost model uses 2014-2018 claims (Hu et al., BMC Health Services Research 2023). The AOM and OME totals come from different methods and different years, so they should not be summed.
Summary: Otitis Media in Children by the Numbers
| Metric | Value | Source |
|---|---|---|
| Children with at least 1 AOM episode by age 1 (2006-2016 cohort) | 23% | Kaur et al., Pediatrics 2017 |
| Children with at least 1 AOM episode by age 3 (2006-2016 cohort) | 60% | Kaur et al., Pediatrics 2017 |
| Children with at least 1 AOM episode by age 3 (Greater Boston cohort) | 83% | Teele et al., Journal of Infectious Diseases 1989 |
| AOM incidence under age 2, 1998-1999 vs 2014-2018 | 1,170.1 vs 768.8 per 1,000 person-years | Hu et al., BMC Infectious Diseases 2022 |
| Otitis media visits per 100 children under 5, pre-vaccine vs PCV13 era | 78 vs 46 | Wasserman et al., Emerging Infectious Diseases 2021 |
| Otitis media visits averted by pneumococcal conjugate vaccines over 20 years | 97 million | Wasserman et al., Emerging Infectious Diseases 2021 |
| Pediatric AOM visits with an immediate antibiotic, 2018-2023 | 84.4% | Jenkins et al., JPIDS 2025 |
| Pediatric AOM visits managed with watchful waiting, 2018-2023 | 15.6% | Jenkins et al., JPIDS 2025 |
| Antibiotic courses lasting 10 days, children aged 2-17 | 75% | Katz et al., JPIDS 2024 |
| Antibiotic days of therapy for AOM per year, US (simulated) | 107 million | Morin et al., Children 2025 |
| Tube insertions in US children under 15, 2010 | 699,000 | CDC NCHS, National Health Statistics Reports No. 102, 2017 |
| US children who have ever had tubes placed, 2014 | 8.6% | Bhattacharyya and Shay, Otolaryngology-Head and Neck Surgery 2020 |
| AOM episodes per child-year, tubes vs medical management | 1.48 vs 1.56 (P = 0.66) | Hoberman et al., NEJM 2021 |
| Children who have OME before school age | About 90% | AAO-HNSF Clinical Practice Guideline: OME 2016 |
| Average hearing loss with OME | 28 dB | AAO-HNSF Clinical Practice Guideline: OME 2016 |
| New otitis media episodes worldwide, 2021 | 391 million | GBD 2021 Collaborators, Lancet Infectious Diseases 2025 |
| Global prevalence of chronic suppurative otitis media | 3.8% (about 297 million people) | Onifade et al., Journal of Epidemiology and Global Health 2025 |
| Share of hearing loss in children under 5 attributed to otitis media | 68.7% | Guo et al., BMC Public Health 2024 |
| Annual cost of AOM in US children | $4.3 billion | Hu et al., BMC Health Services Research 2023 |
Methodology and Sources
We collected roughly 75 statistics from primary research, government surveys, and clinical guidelines, and kept the ones that could be read directly in the source during this review. Figures are reported with the notation the source uses. This article is a statistical summary and is not medical advice.
- Kaur, Morris and Pichichero, Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era, Pediatrics 2017
- Teele, Klein and Rosner, Epidemiology of otitis media during the first seven years of life in children in greater Boston, Journal of Infectious Diseases 1989
- NIDCD, Ear Infections in Children (updated March 2022)
- Ahmed et al., Incremental health care utilization and costs for acute otitis media in children, Laryngoscope 2014
- Hu et al., Incidence of acute otitis media in children in the United States, 1998-2018, BMC Infectious Diseases 2022
- Wasserman et al., Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children, Emerging Infectious Diseases 2021
- Tong et al., Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008-2014, BMC Health Services Research 2018
- Marom et al., Trends in Otitis Media-Related Health Care Use in the United States, 2001-2011, JAMA Pediatrics 2014
- Cochrane Review: de Sévaux et al., Pneumococcal conjugate vaccines for preventing acute otitis media in children, 2020
- Jenkins et al., Watchful Waiting for Children With Acute Otitis Media: Frequency of Use and Outcomes in Clinical Practice, JPIDS 2025
- Smolinski et al., Watchful Waiting for Acute Otitis Media, Pediatrics 2022
- Katz et al., Durations of Antibiotic Treatment for Acute Otitis Media, JPIDS 2024
- Frost et al., Amoxicillin versus other antibiotic agents for treatment of acute otitis media in children, Journal of Pediatrics 2022
- Morin et al., Interventions to Minimize Unnecessary Antibiotic Use for Acute Otitis Media: A Meta-Analysis, Children 2025
- Cochrane Review: Venekamp et al., Antibiotics for acute otitis media in children, 2023
- Hoberman et al., Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children, NEJM 2016
- CDC, Outpatient Clinical Care for Pediatric Populations (April 2024) and CDC, Ear Infection Basics (April 2024)
- CDC NCHS, Ambulatory Surgery in the United States, 2006, National Health Statistics Reports No. 11 (2009)
- CDC NCHS, Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010, National Health Statistics Reports No. 102 (2017)
- Bhattacharyya and Shay, Epidemiology of Pediatric Tympanostomy Tube Placement in the United States, Otolaryngology-Head and Neck Surgery 2020
- Dedhia et al., Temporal Trends in and Patient Characteristics Associated with Surgery for Otitis Media, Laryngoscope 2025
- Hoberman et al., Tympanostomy Tubes or Medical Management for Recurrent Acute Otitis Media, NEJM 2021
- Lüscher et al., Trends in Tympanostomy Tube Insertion Among Children Aged 0-12 Years, Clinical Epidemiology 2026
- Epstein et al., Housing and economic insecurity leads to decreased rates of tympanostomy tube placement, International Journal of Pediatric Otorhinolaryngology 2025
- AAO-HNSF, Clinical Practice Guideline: Otitis Media with Effusion (Update) 2016, release and fact sheet and AAO-HNSF, Clinical Practice Guideline: Tympanostomy Tubes in Children (Update) 2022
- Cai et al., Hearing loss in children with otitis media with effusion: a systematic review, International Journal of Audiology 2017
- Paing et al., Natural history of OME-related hearing loss in children under 12 years, Archives of Disease in Childhood 2024
- Roberts et al., Otitis media and speech and language: a meta-analysis of prospective studies, Pediatrics 2004
- Paradise et al., Tympanostomy tubes and developmental outcomes at 9 to 11 years of age, NEJM 2007
- Cochrane Review: MacKeith et al., Ventilation tubes (grommets) for otitis media with effusion in children, 2023
- GBD 2021 Upper Respiratory Infections Otitis Media Collaborators, Lancet Infectious Diseases 2025
- Dong et al., Trends in the incidence and burden of otitis media in children: a global analysis from 1990 to 2021, European Archives of Oto-Rhino-Laryngology 2025
- Onifade et al., Epidemiology of Chronic Suppurative Otitis Media: Systematic Review To Estimate Global Prevalence, Journal of Epidemiology and Global Health 2025, which also quotes the WHO report Chronic Suppurative Otitis Media: Burden of Illness and Management Options (2004)
- Jin et al., Global burden and prevalence of otitis media-induced hearing loss in children: 32-year study, European Archives of Oto-Rhino-Laryngology 2025
- Guo et al., Global, regional, and national burden of hearing loss in children and adolescents, 1990-2021, BMC Public Health 2024
- Monasta et al., Burden of Disease Caused by Otitis Media: Systematic Review and Global Estimates, PLoS One 2012
- WHO, Deafness and hearing loss fact sheet (3 March 2026)
- Hu et al., Economic burden of acute otitis media, pneumonia, and invasive pneumococcal disease in children in the United States, 2014-2018, BMC Health Services Research 2023
- Data watch: cumulative incidence depends on the diagnostic standard (83% by age 3 with clinical diagnosis in Teele 1989 vs 60% with tympanocentesis in Kaur 2017, a paper that carries a published correction in Pediatrics 2018). Annual US volume estimates use different units and do not agree: 15.8 million AOM episodes (Hu 2023), about 11.5 million AOM encounters with a range of 5.2 to 19.2 million (Morin 2025), and 8.7 million children diagnosed (Ahmed 2014). Wasserman 2021 gives the visit decline as 41% in its abstract and 39% in its results text. Global AOM estimates differ by method: 709 million cases for 2005 (Monasta 2012) vs 391 million otitis media episodes for 2021 (GBD 2021, whose newest non-fatal input data are from 2018). CSOM estimates range from 65-330 million (WHO 2004) to about 297 million (Onifade 2025). The tube trial (Hoberman 2021) showed a lower infection rate with tubes in its per-protocol analysis (risk ratio 0.82, 95% CI 0.69-0.97) but not in the intention-to-treat analysis quoted above (risk ratio 0.97, 95% CI 0.84-1.12). US national tube counts stop at 2010, cohort incidence at 2016, and cost claims at 2018; Global Burden of Disease 2023 otitis media estimates have so far appeared only in country and country-group papers (China, BRICS). The detailed OME figures were read in the full guideline text; the AAO-HNSF link above points to the official release and fact sheet.
Last updated: October 11, 2026. We update this roundup quarterly, and the next refresh is expected when the Global Burden of Disease 2023 otitis media estimates are published in full.