Ból ucha – Epidemiologia

Ból ucha
Epidemiologia

Ból ucha (otalgia) jest częstym objawem, szczególnie u dzieci, z dominującą etiologią pierwotną, głównie ostrym zapaleniem ucha środkowego (AOM), które dotyka 60-80% dzieci przed 3. rokiem życia, ze szczytem zachorowań między 6 a 24 miesiącem życia. Epidemiologia wskazuje, że AOM stanowi około 60,6% przypadków bólu ucha zgłaszanych w oddziałach ratunkowych, a zapalenie ucha zewnętrznego (otitis externa) odpowiada za 11,8%. Wprowadzenie szczepionek przeciwko pneumokokom (PCV7 i PCV13) znacząco zmniejszyło częstość występowania AOM, co potwierdzają spadki wizyt ambulatoryjnych z 9,5% do 5,5% w analizowanych okresach. Ból ucha wtórny, wynikający z promieniowania bólu z innych struktur (np. staw skroniowo-żuchwowy, choroby zębów, kręgosłupa szyjnego), jest częstszy u dorosłych i kobiet, stanowiąc około 1/3 przypadków otalgii. Czynniki ryzyka obejmują m.in. uczęszczanie do żłobka, palenie tytoniu w otoczeniu dziecka, wcześniejsze epizody zapalenia ucha oraz wady anatomiczne jamy nosowo-gardłowej.

Epidemiologia bólu ucha

Ból ucha (otalgia) jest powszechnym objawem, szczególnie u dzieci, stanowiącym częsty powód wizyt w placówkach podstawowej opieki zdrowotnej. Występowanie bólu ucha różni się w zależności od wieku, płci oraz przyczyny, która go wywołuje. Można wyróżnić dwa główne typy bólu ucha: pierwotny (pochodzący bezpośrednio z ucha) oraz wtórny (promieniujący do ucha z innych struktur).¹²

Częstość występowania bólu ucha

Według badań epidemiologicznych, częstość występowania bólu ucha jest znacząca w populacji ogólnej. W badaniu przeprowadzonym w Czadzie wykazano, że częstość występowania bólu ucha wynosiła 22,3%, natomiast dane z innych krajów afrykańskich wskazują na częstość wahającą się od 18% do 36%.¹ W analizie amerykańskich oddziałów ratunkowych stwierdzono, że najczęściej diagnozowanymi schorzeniami u pacjentów z dolegliwościami otologicznymi były: zapalenie ucha środkowego (60,6%), zapalenie ucha zewnętrznego (11,8%) oraz ból ucha bez określonej przyczyny (6,8%).¹

W badaniu obejmującym pacjentów prezentujących ból ucha stwierdzono, że około 2/3 przypadków stanowiła otalgia pierwotna, a 1/3 otalgia wtórna.¹ Choć powszechnie uważa się, że otalgia pierwotna występuje częściej niż wtórna, niektóre badania sugerują, że obie kategorie mogą występować z podobną częstotliwością.¹²

Różnice związane z wiekiem

Występowanie bólu ucha wykazuje wyraźne zróżnicowanie w zależności od wieku pacjentów:

Dzieci: Ból ucha jest szczególnie powszechny u dzieci, stanowiąc drugi po przeziębieniach najczęstszy powód wizyt lekarskich w tej grupie wiekowej. Około 75-80% dzieci doświadcza przynajmniej jednego epizodu bólu ucha związanego z zapaleniem ucha środkowego przed ukończeniem 3 lat życia.¹¹¹
Szczyt zachorowań: Największa częstość występowania ostrego zapalenia ucha środkowego (AOM), będącego główną przyczyną bólu ucha u dzieci, przypada na wiek 6-18 miesięcy (według niektórych źródeł 6-24 miesięcy).¹¹¹
Dorośli: U dorosłych częstość występowania pierwotnego bólu ucha jest znacznie niższa niż u dzieci, natomiast zwiększa się proporcja bólu wtórnego.¹²
Osoby starsze: Pacjenci powyżej 65 roku życia częściej doświadczają bólu ucha pochodzącego z chorób kręgosłupa szyjnego.¹²

Różnice związane z płcią

Badania epidemiologiczne wykazują różnice w występowaniu bólu ucha w zależności od płci:

Mężczyźni częściej cierpią na pierwotny ból ucha¹¹
Kobiety częściej doświadczają bólu ucha wtórnego¹¹
Neuralgia wtórna powodująca ból ucha występuje częściej u kobiet niż u mężczyzn¹
Kobiety w wieku 20-40 lat częściej doświadczają bólu ucha związanego z dysfunkcją stawu skroniowo-żuchwowego (TMJ)¹²
Ostre zapalenie ucha środkowego występuje nieznacznie częściej u chłopców niż u dziewczynek¹¹

Epidemiologia poszczególnych przyczyn bólu ucha

Ostre zapalenie ucha środkowego

Ostre zapalenie ucha środkowego (AOM) stanowi najczęstszą przyczynę pierwotnego bólu ucha u dzieci i jednocześnie jest drugą najczęstszą przyczyną wizyt lekarskich w tej grupie wiekowej, zaraz po przeziębieniu. Szacuje się, że na świecie występuje około 709 milionów przypadków AOM rocznie.¹¹ W 2021 roku globalnie odnotowano 391 milionów epizodów zapalenia ucha środkowego i 536 zgonów z tego powodu.¹²

Dane epidemiologiczne dotyczące AOM wskazują, że:

Około 60-80% dzieci doświadcza przynajmniej jednego epizodu AOM przed ukończeniem 3 lat życia¹¹
Szczyt zachorowań przypada na wiek 6-24 miesięcy¹¹
Po 5 roku życia częstość występowania znacząco spada¹
Nawracające zapalenia ucha środkowego definiuje się jako trzy lub więcej infekcji w ciągu 6 miesięcy lub cztery lub więcej infekcji w ciągu 12 miesięcy¹
W Stanach Zjednoczonych AOM odpowiada za 13,6 miliona wizyt w gabinetach lekarskich wśród dzieci rocznie¹
Najczęstszymi patogenami wywołującymi AOM są Streptococcus pneumoniae, Haemophilus influenzae i Moraxella catarrhalis¹¹

Warto zauważyć, że wprowadzenie szczepionek przeciwko pneumokokom (PCV7 w 2000 r. i PCV13 w 2010 r.) doprowadziło do spadku częstości występowania AOM. Wizyty ambulatoryjne z powodu AOM zmniejszyły się z 9,5% wszystkich wizyt pediatrycznych w latach 1997-1999 do 5,5% w latach 2012-2014.¹¹ Szacuje się, że rutynowe stosowanie szczepionki PCV7 w Kanadzie zmniejszyło częstość występowania AOM o 13% do 19%.¹

Zapalenie ucha zewnętrznego

Zapalenie ucha zewnętrznego (otitis externa) jest kolejną istotną przyczyną bólu ucha, szczególnie u dzieci i młodzieży:

Szczyt zachorowań przypada na wiek 7-12 lat¹
Około 10% osób doświadczyło zapalenia ucha zewnętrznego przynajmniej raz w życiu¹
Dotyka 1 na 200 Amerykanów rocznie i stanowi przewlekły problem u 3-5% populacji¹
Ostre niepowikłane zapalenie ucha zewnętrznego najczęściej występuje u dzieci¹
Złośliwe zapalenie ucha zewnętrznego występuje częściej u pacjentów z obniżoną odpornością (osoby starsze, chorzy na cukrzycę, zakażeni HIV, przyjmujący leki immunosupresyjne)¹
Głównym czynnikiem ryzyka jest długotrwałe przebywanie w wodzie – dotyczy to szczególnie pływaków, surferów i innych osób narażonych na wilgotne i ciepłe warunki¹¹

Inne przyczyny bólu ucha

Oprócz zapaleń ucha środkowego i zewnętrznego, ból ucha może być spowodowany innymi schorzeniami:

Dysfunkcja trąbki słuchowej – występuje u około 3% pacjentów z bólem ucha¹, ale dotyka około 70% dzieci do 7 roku życia, będąc częstą przyczyną niedosłuchu u dzieci¹
Czop woskowinowy – występuje u 1 na 10 dzieci, 1 na 20 dorosłych i 1 na 3 osoby starsze¹
Barotrauma (uraz ciśnieniowy) – występuje u około 1 na 1000 osób¹
Dysfunkcja stawu skroniowo-żuchwowego (TMD) – dotyka około 10% populacji ogólnej powyżej 18 roku życia¹, z czego odsetek pacjentów z bólem ucha waha się od 3% do 100% w zależności od badania¹, a w jednym z badań wykazano istotną zależność między TMD a bólem ucha (iloraz szans = 2,3)¹

Ból ucha pochodzenia wtórnego

Ból ucha wtórny (otalgia wtórna) wynika z promieniowania bólu do ucha z innych struktur poprzez wspólne unerwienie. Epidemiologia bólu ucha wtórnego wykazuje charakterystyczne cechy:

Otalgia wtórna jest częstsza u dorosłych niż u dzieci¹¹
Kobiety częściej cierpią na ból ucha wtórny niż mężczyźni¹¹
U dzieci dominują pierwotne przyczyny bólu ucha, podczas gdy u dorosłych częściej występuje ból ucha wtórny¹²
Ból ucha wtórny może być trudny do zdiagnozowania ze względu na złożone unerwienie ucha i wiele potencjalnych źródeł bólu promieniującego¹

Najczęstsze przyczyny bólu ucha wtórnego obejmują zaburzenia stawu skroniowo-żuchwowego, choroby zębów, zapalenie migdałków, zapalenie gardła oraz choroby kręgosłupa szyjnego. Rzadsze, ale istotne przyczyny to nowotwory głowy i szyi, olbrzymiokomórkowe zapalenie tętnicy skroniowej oraz neuralgię nerwu trójdzielnego.²²

Czynniki ryzyka bólu ucha

Zidentyfikowano liczne czynniki ryzyka związane z występowaniem bólu ucha, szczególnie w kontekście zapalenia ucha środkowego u dzieci:

Uczęszczanie do żłobka lub przedszkola¹
Biała rasa etniczna¹
Płeć męska¹¹
Powiększone migdałki i adenoidy¹
Wcześniejsze epizody zapalenia ucha środkowego¹
Karmienie butelką¹
Używanie smoczka¹
Palenie tytoniu przez rodziców¹¹
Rodzinne występowanie zapalenia ucha środkowego¹¹
Wady anatomiczne jamy nosowo-gardłowej, takie jak rozszczep podniebienia i zespół Downa¹
Obniżona odporność organizmu¹
Wirusowe infekcje górnych dróg oddechowych¹¹

W przypadku bólu ucha związanego z pływaniem w naturalnych zbiornikach wodnych, szacuje się, że na każde 1000 wydarzeń pływackich z zanurzeniem głowy występuje ponad 7 dodatkowych przypadków bólu ucha.¹

Populacje szczególnego ryzyka

Niektóre grupy populacyjne są bardziej narażone na występowanie bólu ucha i jego powikłań:

Rdzenni Amerykanie i rdzenni mieszkańcy Alaski, w tym Inuici, mają wyższe wskaźniki przewlekłego zapalenia ucha środkowego niż osoby rasy białej¹
Osoby z rozszczepem podniebienia, zespołem Downa i innymi anomaliami twarzoczaszki są bardziej narażone na zapalenie ucha środkowego z wysiękowym zapaleniem¹
Aborygenów australijskich doświadczają wysokiego poziomu przewodzeniowych ubytków słuchu głównie z powodu ogromnej częstości występowania chorób ucha środkowego wśród młodzieży w społecznościach aborygeńskich – dzieci aborygeńskie doświadczają chorób ucha środkowego średnio przez dwa i pół roku podczas dzieciństwa w porównaniu z trzema miesiącami u dzieci niebędących Aborygenami¹
Pacjenci z jednostronnym bólem ucha, którzy są w wieku powyżej 50 lat i którzy palą, piją alkohol lub mają cukrzycę, są bardziej narażeni na poważne ukryte przyczyny bólu ucha¹

Obciążenie zdrowotne i ekonomiczne

Ból ucha, a szczególnie zapalenie ucha środkowego, stanowi znaczące obciążenie dla systemu opieki zdrowotnej i gospodarki:

Zapalenie ucha wysiękowe (OME) jest jedną z najczęściej występujących chorób wieku dziecięcego w Stanach Zjednoczonych, z ponad 2,2 milionami zdiagnozowanych przypadków rocznie, przy szacunkowym rocznym koszcie 4 miliardów dolarów¹
W badaniu dotyczącym dzieci poniżej 5 roku życia w Stanach Zjednoczonych oszacowano, że koszt leczenia zapalenia ucha środkowego wynosi około 4,8 miliarda dolarów¹
Obciążenie zdrowotne i ekonomiczne związane z bólem ucha wywołanym pływaniem jest znaczne – na podstawie szacunków amerykańskich, te bóle ucha prowadziłyby do 260 000 wizyt lekarskich, 39 900 wizyt na oddziale ratunkowym i prawie 4 milionów dolarów wydanych na leki na receptę i bez recepty¹
W 2007 roku w USA odnotowano około 2,4 miliona wizyt w placówkach opieki zdrowotnej (8,1 wizyt na 1000 populacji) związanych z diagnozą ostrego zapalenia ucha zewnętrznego¹

Powikłania i rokowanie

Większość przypadków bólu ucha, szczególnie związanych z ostrym zapaleniem ucha środkowego, ustępuje samoistnie bez poważnych powikłań:

U około 80-85% dzieci z AOM gorączka i ból ustępują w ciągu 2-3 dni¹
Po 7 dniach można oczekiwać ustąpienia wszystkich objawów i symptomów (z wyjątkiem wysięku w uchu środkowym)¹
Powikłania AOM, takie jak zapalenie wyrostka sutkowatego i zapalenie opon mózgowych, kiedyś umiarkowanie częste, są obecnie niezwykle rzadkie w krajach rozwiniętych¹
Podawanie antybiotyków nie zapobiega tym powikłaniom¹
Poważne powikłania dotyczą mniej niż 0,1% dzieci z infekcjami ucha, niezależnie od tego, czy dziecko przyjmuje antybiotyk¹

Wiele epizodów wysiękowego zapalenia ucha środkowego (OME) ustępuje samoistnie w ciągu 3 miesięcy, ale 30-40% dzieci ma nawracające epizody, a 5-10% przypadków trwa dłużej niż rok.¹ Częstość występowania przedłużającego się OME u dorosłych nie jest znana, ale jest znacznie mniej powszechna niż u dzieci.¹

Globalnie szacuje się, że utrata słuchu spowodowana infekcją ucha dotyczy 30 osób na 10 000.¹ Na całym świecie odnotowuje się około 21 000 do 28 000 zgonów rocznie z powodu powikłań infekcji ucha.¹ Jeśli zapalenie ucha środkowego nie jest leczone, może pozostawić trwały ślad w postaci ubytku słuchu.¹

Tendencje i zmiany w epidemiologii bólu ucha

W ostatnich dekadach zaobserwowano pewne zmiany w epidemiologii bólu ucha i jego przyczyn:

Wprowadzenie szczepionek przeciwko pneumokokom (PCV7 w 2000 r. i PCV13 w 2010 r.) doprowadziło do zmniejszenia częstości występowania AOM¹¹
Odsetek wizyt ambulatoryjnych z powodu AOM spadł z 9,5% w latach 1997-1999 do 5,5% w latach 2012-2014¹
Zmienił się profil patogenów wywołujących AOM – zakażenia wywołane przez nieszczepialne szczepy Haemophilus influenzae stały się częstsze niż zakażenia wywołane przez szczep typu B Haemophilus influenzae, przeciwko któremu obecnie istnieje szczepionka¹
W ciągu ostatnich 30 lat zaobserwowano tendencję spadkową w zakresie zapadalności, chorobowości, śmiertelności i DALY (lata życia skorygowane niesprawnością) z powodu zapalenia ucha środkowego, co jest korzyścią z poprawy profilaktyki i leczenia¹

Mimo tych pozytywnych zmian, zapalenie ucha środkowego pozostaje częstą chorobą u małych dzieci, szczególnie między 9 a 12 miesiącem życia.¹ Potrzebne są nowe metody zapobiegania zapaleniu ucha środkowego, które powinny być stosowane wcześnie w życiu, ponieważ wskaźniki zachorowań zaczynają wzrastać od 6 miesiąca życia.¹

Nadzór epidemiologiczny nad bólem ucha

Biorąc pod uwagę znaczne obciążenie zdrowotne i ekonomiczne związane z bólem ucha i jego przyczynami, istnieje potrzeba ciągłego nadzoru epidemiologicznego:

Konieczny jest dalszy nadzór epidemiologiczny nad globalnymi wzorcami zapalenia ucha środkowego, dystrybucją patogenów i opornością na antybiotyki¹
Potrzebne są dokładniejsze szacunki dotyczące ekspozycji na pływanie, aby poprawić oceny obciążenia populacji i związanych z tym kosztów¹
Brakuje systematycznych badań populacyjnych dotyczących epidemiologii różnych form bólu związanych z chorobami uszu¹
W Afryce przeprowadzono niewiele badań poświęconych epidemiologii i etiologii bólu ucha¹

Lepsze zrozumienie epidemiologii bólu ucha pomoże w opracowaniu skuteczniejszych strategii profilaktyki, diagnostyki i leczenia tego powszechnego problemu zdrowotnego.

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Otalgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK549830/
Ear complaints are relatively common reasons for presentation to primary care. Primary causes are more common overall. Men are most commonly afflicted with primary otalgia, while women are more likely to have secondary otalgia. Most pediatric otalgia cases are primary, with acute otitis media (AOM) being the most common. About 80% of children will have at least 1 otitis media episode before age 3. AOM produces a significant disease burden in the United States. This condition accounted for 9.5% of all pediatric outpatient visits from 1997 to 1999. […] While primary otalgia is thought to be more common than secondary otalgia, some studies report that primary and secondary cases are equally frequent. Adults and women with otalgia are more likely to have secondary causes. […] Patients older than 65 are more likely to experience otalgia from cervical spine disease. Women aged 20 to 40 are more likely to experience TMJ dysfunction. Malignancies or distant secondary causes, such as thyroid, cardiac, gastrointestinal, or lung pathology, are rare but must be considered during patient examination, especially if medical history reveals risk factors.
#1 Epidemiological, clinical and aetiological aspects of otalgia at the Renaissance University Hospital | The Egyptian Journal of Otolaryngology | Full Text
https://ejo.springeropen.com/articles/10.1186/s43163-022-00240-y
Otalgia is a frequent reason for medical consultation. In Africa, few studies have been devoted to the epidemiology and aetiology of otalgia. To our knowledge, no study has been carried out in Chad. […] The objective of this study is to describe the epidemiological, clinical and aetiological aspects of otalgia in Chadian hospitals. […] The prevalence of otalgia in our study was high (22.3%). This prevalence varied from 18% to 36% according to authors in Africa. […] The main aetiologies of otogenic otalgia found in our study were otitis externa and chronic otitis media. […] Depending on the age group, our study showed that the causes of otalgia differed between children and adults. Ear diseases were the most common cause of otalgia in children, while reflex otalgia was more common in adults.
#1 Otalgia: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/845173-overview
In a study of US emergency department (ED) patients with otologic complaints, Kozin et al found that the most commonly diagnosed conditions were otitis media not otherwise specified (NOS) (60.6%), infected otitis externa NOS (11.8%), and otalgia NOS (6.8%). The data was drawn from a weighted total of 8,611,282 ED visits for otologic problems between 2009 and 2011. […] In a Korean study of 294 patients with otalgia, the prevalence of primary otalgia was found to be higher in children than in adults and in men than in women, while referred otalgia was more likely to occur in adults in general and in women in particular. The study, by Kim et al, also found that neuralgia occurred more frequently in women than in men with referred otalgia.
#1 Ear pain – Wikipedia
https://en.wikipedia.org/wiki/Ear_pain
2/3 of people presenting with ear pain were diagnosed with some sort of primary otalgia and 1/3 were diagnosed with some sort secondary otalgia. […] A common cause of primary otalgia is ear infection called otitis media, meaning an infection behind the eardrum. […] The peak age for children to get acute otitis media is ages 6-24 months. […] One review paper wrote that 83% of children had at least one episode of acute otitis media by 3 years of age. […] Worldwide, there are 709 millions cases of acute otitis media every year. […] Hearing loss globally due to ear infection is estimated to be 30 people in every 10,000. […] Around the world there is around 21,000 to 28,000 deaths due to complications from ear infections. […] Otitis externae peaks at age 7-12 years of age and around 10% of people has had it at least once in their lives. […] Cerumen impaction occurs in 1 out of every 10 children, 1 in every 20 adults and 1 in every 3 elderly citizens. […] Barotrauma occurs around 1 in every 1000 people. […] Of people presenting with ear pain, only 3% was diagnosed with eustachian tube dysfunction.
#1 Ear Infections in Children: Causes, Signs and Treatment – Children’s Health
https://www.childrens.com/health-wellness/ear-infections-educational-resources
An ear infection is the number one reason parents bring a child to the doctor. While rare in adults, 75% of kids will develop an ear infection by the time they are 3 years old. […] An ear infection usually follows a respiratory infection such as a cold or a sore throat. […] This is the most common type of ear infection and is also known as an „earache.” […] Many ear infections happen before your child is able to speak. […] Your child’s doctor will begin a diagnosis by asking you if your child has had a cold or sore throat. […] An ear infection usually goes away on its own but, if it doesn’t, your child may need treatment. […] If your child has repeated ear infections within a short period of time, or has hearing loss due to fluid build-up, your child’s physician may recommend ear tube surgery. […] The Centers for Disease Control and Prevention (CDC) recommends the following to help prevent ear infections in children: Avoid exposing your child to secondhand smoke or air pollution.
#1 Ear Infections-What you need to know to help your child | Texas DSHS
https://dshs.texas.gov/vision-hearing-screening/hearing-screening-program/ear-infections-what-you
Young children often get ear infections. Three out of every four children have at least one by the time they are 5 years old. Some children can get them repeatedly. A child may have several in less than a year. […] If you think there is fluid in the middle ear, take your child to a doctor or nurse. Doctors and nurses have a name for fluid in the middle ear. They call it otitis media. And they know how to treat it. […] If your child gets several ear infections in a year, the doctor may prescribe medicine for a longer time. The doctor may also refer your child to a special doctor, called an Otologist, otolaryngologist, or Ear, Nose, and Throat (ENT) doctor.
#1 Acute earache
https://pmc.ncbi.nlm.nih.gov/articles/PMC3173423/
Acute otitis media (AOM) is predominantly a disease of children; you will rarely see an adult with it. After the common cold, it is the second most common reason why children are brought to their FPs. About 30% of children younger than 3 years of age visit their FPs with AOM each year, and by their third birthdays 80% to 90% of children have experienced AOM. The peak incidence is between 6 and 15 months; after 5 years of age, the incidence rate drops rapidly. Attendance at a day-care centre or nursery school greatly increases the risk of AOM; other risk factors are white ethnic origin, male sex, enlarged tonsils and adenoids, a previous history of AOM, bottle feeding, use of a dummy or soother, parental smoking, a family history of AOM, and the presence of anatomic disorders of the nasopharynx such as cleft palate and Down syndrome.
#1 Otitis Media: Rapid Evidence Review | AAFP
https://www.aafp.org/pubs/afp/issues/2019/0915/p350.html
AOM is the most common diagnosis in childhood acute sick visits, accounting for 13.6 million office visits among children annually. […] The incidence of AOM peaks between six and 15 months of age. […] AOM is marginally more common in boys than in girls. […] By three years of age, 50% to 85% of children experience at least one episode of AOM. However, after 24 months of age, the risk decreases with increasing age. […] Risk factors for AOM are shown in Table 1. The most common causative bacterial species are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
#1 Acute otitis media – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/acute-otitis-media/
Highest incidence between 624 months of age. […] Approx. 6080% of children 3 years old experience AOM at least once. The incidence of AOM has been declining since the introduction of the pneumococcal and influenza vaccinations. […] Epidemiological data refers to the US, unless otherwise specified.
#1 Middle Ear, Eustachian Tube, Inflammation/Infection: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/858777-overview
Males have a higher prevalence of acute otitis media (AOM) and undergo myringotomies and tympanoplasties, more frequently than females do. […] Middle ear dysfunction and eustachian tube dysfunction (ETD) are more common in the pediatric age group. Peak incidence of otitis media (OM) is in the first 2 years of life.
#1 Otitis media – Wikipedia
https://en.wikipedia.org/wiki/Otitis_media
Acute otitis media is very common in childhood. It is the most common condition for which medical care is provided in children under five years of age in the US. Acute otitis media affects 11% of people each year (709 million cases) with half occurring in those below five years. Chronic suppurative otitis media affects about 5% or 31 million of these cases with 22.6% of cases occurring annually under the age of five years. Otitis media resulted in 2,400 deaths in 2013 down from 4,900 deaths in 1990. […] Australian Aboriginals experience a high level of conductive hearing loss largely due to the massive incidence of middle ear disease among the young in Aboriginal communities. Aboriginal children experience middle ear disease for two and a half years on average during childhood compared with three months for non indigenous children. If untreated it can leave a permanent legacy of hearing loss. The higher incidence of deafness in turn contributes to poor social, educational and emotional outcomes for the children concerned. Such children as they grow into adults are also more likely to experience employment difficulties and find themselves caught up in the criminal justice system. Research in 2012 revealed that nine out of ten Aboriginal prison inmates in the Northern Territory suffer from significant hearing loss.
#1 Study highlights hefty global burden of upper respiratory and ear infections | CIDRAP
https://www.cidrap.umn.edu/antimicrobial-stewardship/study-highlights-hefty-global-burden-upper-respiratory-and-ear-infections
A new study illustrates the substantial global burden of upper respiratory and ear infections, researchers reported this week in The Lancet Infectious Diseases. […] Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study, an international team of researchers explored the fatal and non-fatal burden of upper respiratory infections (URIs) and otitis media (a common complication of URIs typically called ear infections) across all age-groups in 2014 countries and territories from 1990 to 2021, focusing on children younger than 5 years. […] In 2021, there were 12.8 billion URI episodes and 19,600 deaths due to URIs, while otitis media accounted for 391 million episodes and 536 deaths. […] Given the close association between URIs and otitis media, the authors say there is a need for comprehensive strategies that address prevention, early diagnosis, and effective management of these conditions together. […] The potential for URIs to progress to more severe diseases, their contribution to AMR, and the pandemic potential of some URI pathogens necessitate comprehensive research and evidence-based strategies.
#1 Patient education: Ear infections (otitis media) in children (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/ear-infections-otitis-media-in-children-beyond-the-basics
Ear infections are a common problem in children. By three years of age, over 60 percent of children will have had at least one ear infection, and over 25 percent will have had three or more infections. […] Children with recurrent ear infections may be at increased risk for complications from their infections. […] Complications from ear infections are rare whether or not a child takes an antibiotic. Severe complications affect fewer than 0.1 percent of children with ear infections. […] Recurrent ear infections are defined as three or more infections in six months, or four or more infections within 12 months. […] If your child has had recurrent infections, your clinician may talk to you about the different options for preventing new infections, including expectant management (closely observing your child over time and treating ear infections as needed), preventive antibiotics to take daily, and/or surgery.
#1 Management of acute otitis media in children six months of age and older | Canadian Paediatric Society
https://cps.ca/documents/position/acute-otitis-media
Acute otitis media (AOM) continues to be a common infection in young children. […] AOM is extremely common, and 75% of children experience at least one ear infection before starting school. […] Risk factors for AOM include young age and frequent contact with other children, which increases exposure to viral illnesses. […] A small proportion of children have lower levels of secretory immunoglobulin A or persistent biofilms in the middle ear, which may play a role in increasing the risk for recurrent AOM. […] The most common bacteria causing AOM are S pneumoniae, H influenzae, M catarrhalis and (less commonly) GAS. […] It has been estimated that the routine use of PCV7 in Canada has decreased the incidence of AOM by 13% to 19% because nasopharyngeal colonization with vaccine-type S pneumoniae in children has been significantly reduced.
#1 Otalgia | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/26421
Ear complaints are relatively common reasons for presentation to primary care. Primary causes are more common overall. Men are most commonly afflicted with primary otalgia, while women are more likely to have secondary otalgia. Most pediatric otalgia cases are primary, with acute otitis media (AOM) being the most common. About 80% of children will have at least 1 otitis media episode before age 3. AOM produces a significant disease burden in the United States. This condition accounted for 9.5% of all pediatric outpatient visits from 1997 to 1999. […] Streptococcus pneumoniae is the most common cause of AOM. Pneumococcal conjugate vaccines 7 and 13 were approved in 2000 and 2010, respectively, to provide immunity against Streptococcus pneumoniae. Consequently, the percentage of outpatient AOM visits decreased from 9.5% to 5.5% between 2012 and 2014. AOM from non-typeable Haemophilus influenzae infection has become more frequent than AOM from type B Haemophilus influenzae infection, which currently has a vaccine.
#1 Study: Ear infection profile shows change after pneumococcal vaccine introduction | CIDRAP
https://www.cidrap.umn.edu/antimicrobial-stewardship/study-ear-infection-profile-shows-change-after-pneumococcal-vaccine
Ear infections in young children have declined over the past decade since pneumococcal conjugate vaccines were introduced, and though infections from Streptococcus pneumoniae the main cause of such infections have dropped, other pathogens have stepped in as the main sources, researchers reported yesterday. […] The findings, from a longitudinal study published yesterday in an early online issue of Pediatrics, provide one of the first glimpses of the epidemiology of acute otitis media (AOM) since the 1980s, before pneumococcal conjugate 7 and 13 vaccines were introduced. […] The researchers concluded that the epidemiology but not the risk factors have changed substantially since the introduction of pneumococcal conjugate vaccines and the use of more stringent diagnostic criteria. […] The main take-away from the study is that AOM incidence seems to be decreasing as use of pneumococcal vaccine expands.
#1 Swimmer’s Ear (Otitis Externa) – Divers Alert Network
https://dan.org/health-medicine/health-resources/diseases-conditions/swimmers-ear-otitis-externa/
Swimmers ear affects one in 200 Americans every year and is a chronic problem in 3 to 5 percent of the population. […] Swimmers, surfers and other people who are exposed to wet and warm conditions are at increased risk.
#1
https://step2.medbullets.com/ear-nose-throat/120129/otitis-externa
Epidemiology […] Incidence […] acute uncomplicated otitis externa is most common in children […] malignant otitis externa is more common in immunocompromised patients (e.g., elderly, diabetes, HIV, and on immunosuppresants) […] […] […] Risk factors […] prolonged swimming […] […] […] Complications […] Malignant otitis externa […] most commonly seen in immunocompromised patient […] caused by spread of the infection to the bone and marrow from the skin […] the diagnosis is supported by CT and MRI findings of bone involvement
#1 Middle Ear, Eustachian Tube, Inflammation/Infection: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/858777-overview
In the era of modern medicine, middle ear infection infrequently leads to mortality, except in rare cases of intracranial spread of infection. […] Eustachian tube dysfunction (ETD) and chronic otitis media with effusion (COME) affect 70% of children by age 7 years and are common causes of childhood hearing loss. […] Otitis media (OM) has not clearly been shown to affect the long-term acquisition of language skills in children; however, studies have predicted that early recurrent otitis media (OM) and chronic otitis media with effusion (COME) may be predictive of future decreases in hearing as measured by school screening tests and a decrease in overall school achievement. […] American Indian and Native Alaskan children, including the Inuit, have higher rates of chronic otitis media (COM) than Whites.
#1 Otalgia from temporomandibular disorder in Ear, Nose and Throat surgery: a literature review and diagnostic algorithm – Petrides – Australian Journal of Otolaryngology
https://www.theajo.com/article/view/4713/html
ENT surgeons should maintain a high index of suspicion for TMD in patients presenting with otalgia to their clinics, particularly where primary ear disease is excluded. […] The diagnosis of TMD can be made easily using the TMD-pain screener based on the presence of otalgia modified by movement of the jaw and elicitation of familiar pain on palpation of the temporalis and masseter muscles. […] To ensure the alleviation of the patients symptoms, ENT surgeons are responsible for commencing conservative management and involving a multidisciplinary care team of physiotherapists, dental practitioners, mental health professionals, and oral and maxillofacial surgeons. […] Pain-related TMD affects approximately 10% of the general population over the age of 18. […] The proportion of these patients reporting otalgia varies considerably in published studies with rates ranging from 3% to 100% of the total TMD population.
#1
https://www.scielo.br/j/iao/a/CKw3czGC3q8qNg5MC68KpRM/?lang=en
An earache (otalgia or ear pain) is pain in one or both ears that may last a short or long time. […] Earache is prevalent in the population with temporomandibular joint disorders (TMJDs), but there is a dearth of epidemiologic studies regarding the association between TMJD and ear pain and ear fullness in older people. […] There was a significant association (p= 0.036) between the TMJD and earache (odds ratio = 2.3), but there was no significant association between the TMJD and ear fullness. […] The significant association (chi-square = 4.398, p = 0.036) between the TMD (temporomandibular disorder) and earache in this study population highlights the importance of identifying risk factors for ear pain that can be modified through specific interventions. […] This research demonstrated a significant association between TMJD and earache complaints but there was no a significant association between the TMJD and ear fullness.
#1 Ear Pain: Diagnosing Common and Uncommon Causes | AAFP
https://www.aafp.org/pubs/afp/issues/2018/0101/p20.html
Otalgia (ear pain) is a common presentation in the primary care setting with many diverse causes. Pain that originates from the ear is called primary otalgia, and the most common causes are otitis media and otitis externa. […] Primary otalgia is more common in children, whereas secondary otalgia is more common in adults. […] The etiology of primary otalgia, which is usually identified on examination of the ear, is typically otitis externa or otitis media. […] The etiology of secondary otalgia is more complex because the nerves innervating the ear have a shared distribution to include the head, neck, chest, and abdomen. […] The diagnosis of primary otalgia rarely requires more than a history and physical examination. Likewise, most cases of secondary otalgia can be diagnosed with a history and physical examination.
#1 Otalgia | MedLink Neurology
https://www.medlink.com/articles/otalgia
In most cases of otalgia in children, the otalgia is primary, whereas less than half of the cases of otalgia in adults are primary. […] The cause of secondary otalgia may be difficult to identify because of the complex innervation of the ear and the many potential sources of referred pain. […] Most cases of primary otalgia are not neurologic. Referred otalgia is common, but diagnosis may be difficult given the vast range of potential etiologies that can be referred through the extensive sensory innervation of the ear. […] Secondary otalgia may be caused by a wide variety of inflammatory, infectious, neoplastic, musculoskeletal, and vascular disorders of the head and neck, including disorders of the paranasal sinuses and nasal cavity, nasopharynx and retropharynx, the oropharynx and oral cavity. […] Patients with unilateral otalgia who are older than 50 years and who smoke, drink alcohol, or have diabetes are more likely to have a serious occult cause of ear pain. […] If no ear disease is identified, secondary otalgia is likely, but unfortunately, no simple diagnostic algorithm is available.
#1
https://step2.medbullets.com/ear-nose-throat/120128/otitis-media
Incidence: peak of acute otitis media infection is between 6-18 months of age […] Risk factors: immunocompromise […] viral upper respiratory tract infection […] family history
#1 The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study | Environmental Health | Full Text
https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-12-67
For every 1000 swimming events in natural waters there were slightly more than 7 excess earaches. […] The health care burden and economic impacts of swimming-associated earaches are substantial. […] Assuming the burden estimates we observed apply nationally, these earaches would result in 260,000 visits to the doctor, 39,900 visits to the emergency room and nearly $4 million dollars spent on prescription and over-the-counter medications due to earaches associated with swimming in natural waters. […] The costs for over-the-counter and prescription medications reported by participants are a fraction of the direct health care cost of earache. […] In summary, from an analysis of over 39,000 beachgoers at nine freshwater and marine beach sites there were 7.12 excess earaches for every 1,000 head immersion swimming events. […] As there are over 128 million swimming events in natural waters annually, the population health burden attributable to swimming-associated earaches is considerable.
#1 Otitis Media With Effusion: Comparative Effectiveness of Treatments | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/ear-infection/research-protocol
Otitis media with effusion (OME) is one of the most commonly occurring childhood illnesses in the United States with more than 2.2 million diagnosed cases each year at an estimated annual cost of 4 billion dollars. […] Many episodes of OME resolve spontaneously within 3 months, but 30 to 40 percent of children have recurrent episodes and 5 to 10 percent of cases last more than 1 year. […] Additionally, some subpopulations of children are disproportionately affected by OME. Those with cleft palate, Down syndrome, and other craniofacial anomalies are at high risk for anatomic causes of OME in addition to worsened function of the Eustachian tube. […] Individuals of American Indian, Alaskan, and Asian backgrounds are believed to be at greater risk, as are children with adenoid hyperplasia.
#1
https://tandf.figshare.com/articles/journal_contribution/Clinical_and_economic_burden_of_otitis_media_in_children_under_5_years_of_age_in_the_United_States_A_retrospective_study/27255996
Reductions in all-cause otitis media (OM) following widespread pneumococcal conjugate vaccine use have plateaued. […] We assessed the burden of middle ear infection in children aged less than 5 years in the United States (US) and estimated the cost to the healthcare system. […] The study showed that middle ear infection is still a very common disease in young children, especially between 9 and 12 months of age. […] We estimated that the cost of treating middle ear infection in the US is USD 4.8 billion. […] Middle ear infection remains a common disease in young children. […] New methods to prevent middle ear infection need to be given early in life because disease rates start to increase from the age of 6 months.
#1 The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study | Environmental Health | Full Text
https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-12-67
Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States. […] The overall incidence of self-reported earache was 1.6% in the 1012 days after the beach visit. […] After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. […] More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates. […] The health-care burden associated with earaches and ear infections is considerable. An estimated 2.4 million U.S. health-care visits (8.1 visits per 1,000 population) were associated with a diagnosis of acute otitis externa (ambulatory care or emergency room) in 2007.
#1 Acute earache
https://pmc.ncbi.nlm.nih.gov/articles/PMC3173423/
Your patient has an earache, a cloudy tympanic membrane, and a history of previous AOM, all of which increase the chances of AOM being present. […] The natural history of AOM has been elucidated by the experiences of thousands of placebo-group subjects in the trials of antibiotic treatment. It has been estimated that in around 80% to 85% of children with AOM, the fever and pain resolve within 2 to 3 days; after 7 days, the absence of all symptoms and signs (except for middle ear effusion) can be expected. These trials for children with AOM showed that very few treated children developed complications, but neither did those children who were given placebo. Very few suppurative complications occurred either in the placebo or intervention groups. Complications of AOM, such as mastoiditis and meningitis, once moderately common, are now extremely rare in developed countries. Administration of antibiotics does not prevent these complications.
#1 Otitis Media With Effusion: Comparative Effectiveness of Treatments | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/ear-infection/research-protocol
The incidence of prolonged OME in adults is not known, but it is much less common than in children. […] OME can be associated with discomfort and a feeling of fullness in the ear. […] Patients with OME are also prone to episodes of acute otitis media (AOM). […] Temporary hearing loss is common among OME patients. […] Because hearing loss in young children may delay or permanently change their communication skills and may lead to behavioral and educational difficulties, there has been concern about the possible role of OME on these outcomes. […] Diagnostically, OME must be first identified and then distinguished from AOM. […] OME is diagnosed with the presence of fluid behind the tympanic membrane, without acute onset or signs of inflammation or infection. […] Tympanocentesis (use of a needle to puncture the tympanic membrane to allow for fluid drainage, aeration), usually performed at the time of myringotomy with or without tympanostomy tube placement, remains the gold standard for diagnosing OME.
#1
https://journals.lww.com/ear-hearing/fulltext/2024/05000/global,_regional,_and_national_burdens_of_otitis.12.aspx
Over the past 3 decades, the incidence, prevalence, mortality, and DALYs for otitis media have shown a downward trend, which is a benefit of the improvement in prevention and treatment. […] Ongoing epidemiologic surveillance of the global patterns of otitis media, pathogen distribution, and resistance is warranted.
#1 Disorder of Ear, Nose, and Sinus | Anesthesia Key
https://aneskey.com/disorder-of-ear-nose-and-sinus/
EPIDEMIOLOGY No systematic population-based studies of the epidemiology of the different forms of pain associated with diseases of the ears are known. […] A Spanish study analyzed the epidemiology of acute otitis media in 20,532 schoolchildren over a 6-month period. […] The most frequent symptom of otitis media, in 92.7% of cases, was earache. […] In general, earache is a frequent symptom, especially in children. […] An analysis of the most frequent symptoms in the emergency department of a university pediatric clinic showed that five symptoms were responsible for 40% of all consultations: high temperature, vomiting or diarrhea (or both), infection of the upper respiratory tract, earache, and skin rashes. […] Otitis media is thus one of the most frequent causes of earache. […] A study that analyzed the symptoms of nasopharyngeal carcinomas revealed that deafness and earache, encountered in 85% of cases, were the most common symptoms besides swelling of the throat. […] The most common cause of intracranial abscesses, with a frequency of 73%, was chronic infection of the middle ear. […] The clinical symptoms are characterized by chronic otitis with otorrhea, earache, headache in the region of the temples, high temperature, nausea, and vomiting.
#2 Ear Pain: Diagnosing Common and Uncommon Causes | AAFP
https://www.aafp.org/pubs/afp/issues/2018/0101/p20.html
Otalgia (ear pain) is a common presentation in the primary care setting with many diverse causes. Pain that originates from the ear is called primary otalgia, and the most common causes are otitis media and otitis externa. […] Primary otalgia is more common in children, whereas secondary otalgia is more common in adults. […] The etiology of primary otalgia, which is usually identified on examination of the ear, is typically otitis externa or otitis media. […] The etiology of secondary otalgia is more complex because the nerves innervating the ear have a shared distribution to include the head, neck, chest, and abdomen. […] The diagnosis of primary otalgia rarely requires more than a history and physical examination. Likewise, most cases of secondary otalgia can be diagnosed with a history and physical examination.
#2 Otalgia | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/26421
While primary otalgia is thought to be more common than secondary otalgia, some studies report that primary and secondary cases are equally frequent. Adults and women with otalgia are more likely to have secondary causes. While the literature is inconsistent, TMJ, dental pathology, tonsillitis, and pharyngitis are cited as among the most common secondary otalgia causes. […] Patients older than 65 are more likely to experience otalgia from cervical spine disease. Women aged 20 to 40 are more likely to experience TMJ dysfunction. Malignancies or distant secondary causes, such as thyroid, cardiac, gastrointestinal, or lung pathology, are rare but must be considered during patient examination, especially if medical history reveals risk factors. Other secondary etiologies, such as petrous apicitis, malignant otitis externa, and Eagle syndrome, are also uncommon. However, migraine-associated otalgia is increasingly being recognized.
#2 Epidemiological, clinical and aetiological aspects of otalgia at the Renaissance University Hospital | The Egyptian Journal of Otolaryngology | Full Text
https://ejo.springeropen.com/articles/10.1186/s43163-022-00240-y
The analysis of the aetiologies of otalgia according to gender in our study showed no significant difference between males and females. […] Earache is a frequent reason for medical consultation at any age and for any gender. However, ear infections are more frequent in children. Reflex otalgia predominates in adults by pharyngeal infections, trigeminal neuralgia and oral cavity, pharyngeal and laryngeal cancers.
#2
https://journals.lww.com/ear-hearing/fulltext/2024/05000/global,_regional,_and_national_burdens_of_otitis.12.aspx
Over the past 3 decades, the incidence, prevalence, mortality, and DALYs for otitis media have shown a downward trend, which is a benefit of the improvement in prevention and treatment. […] Ongoing epidemiologic surveillance of the global patterns of otitis media, pathogen distribution, and resistance is warranted.
#2 Ear Pain: Diagnosing Common and Uncommon Causes | AAFP
https://www.aafp.org/pubs/afp/issues/2018/0101/p20.html
Secondary otalgia can be caused by irritation of C2 and C3 cervical nerve roots, especially in patients with cervical spine degeneration. […] Temporal arteritis should be considered in patients 50 years or older who have normal ear examination findings and any of the following symptoms: headache, malaise, weight loss, fever, or anorexia. […] There are some characteristics that make a serious diagnosis more likely in patients with otalgia. Treatment is most effective when there is minimal delay after diagnosis.