Otitis media across nine countries: Disease burden and management

ObjectiveTo assess the perceived disease burden and management of otitis media (OM) among an international cohort of experienced physicians.MethodsA cross-sectional survey conducted in France, Germany, Spain, Poland, Argentina, Mexico, South Korea, Thailand and Saudi Arabia. Face-to-face interviews conducted with 1800 physicians (95% paediatricians, 5% family practitioners).Main outcome measures were the perceived burden on clinical practice (number of cases, complications and referrals) and first- and second-line management strategies for OM. Results are expressed as mean and range across the nine countries over three continents.ResultsRespondents estimated an average annual caseload of 375 (range 128–1003) children under 5 years of age with OM; 54% (range 44–71%) with an initial episode and 38% (range 27–54%) with recurrent OM (ROM). OM with complications was estimated to be approximately 20 (range 7–49) cases per year and an estimated 15% (8–41%) of children with OM was recalled as needing specialist referral.There was high awareness of Streptococcus pneumoniae and Haemophilus influenzae as causative bacterial pathogens: 77% (range 65–91%) and 74% (range 68–83%), respectively, but less recognition of non-typeable H. influenzae (NTHi); 59% (range 45–67%).Although concern over antimicrobial resistance was widespread, empirical treatment with antibiotics was the most common first-line treatment (mean 81%, range 40–96%). The burden of disease is substantial enough that many physicians would consider vaccination to prevent OM (mean score 5.1, range 4.3–6.2 on 1–7 scale).ConclusionsThis large, multinational survey shows that OM remains a significant burden for clinical practice. Despite awareness of shortcomings, antimicrobial therapy remains the most frequent treatment for OM.