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, 7 (4), e36226

Burden of Disease Caused by Otitis Media: Systematic Review and Global Estimates


Burden of Disease Caused by Otitis Media: Systematic Review and Global Estimates

Lorenzo Monasta et al. PLoS One.


Background: Otitis media (OM) is a leading cause of health care visits and drugs prescription. Its complications and sequelae are important causes of preventable hearing loss, particularly in developing countries. Within the Global Burden of Diseases, Injuries, and Risk Factors Study, for the year 2005 we estimated the incidence of acute OM, chronic suppurative OM, and related hearing loss and mortality for all ages and the 21 WHO regional areas.

Methods: We identified risk factors, complications and sequelae of OM. We carried out an extensive literature review (Medline, Embase, Lilacs and Wholis) which lead to the selection of 114 papers comprising relevant data. Data were available from 15 of the 21 WHO regions. To estimate incidence and prevalence for all countries we adopted a two stage approach based on risk factors formulas and regression modelling.

Results: Acute OM incidence rate is 10.85% i.e. 709 million cases each year with 51% of these occurring in under-fives. Chronic suppurative OM incidence rate is 4.76 ‰ i.e. 31 million cases, with 22.6% of cases occurring annually in under-fives. OM-related hearing impairment has a prevalence of 30.82 per ten-thousand. Each year 21 thousand people die due to complications of OM.

Conclusions: Our study is the first attempt to systematically review the available information and provide global estimates for OM and related conditions. The overall burden deriving from AOM, CSOM and their sequelae is considerable, particularly in the first five years of life and in the poorest countries. The findings call for incorporating OM-focused action within preventive and case management strategies, with emphasis on the more affected.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Figure 1
Figure 1. Sequelae of OM (complete scheme) with ICD-10-CM diagnosis codes.
Figure 2
Figure 2. Screening process of articles on epidemiology of AOM, CSOM and HI, according to the PRISMA 2009 Flow Diagram.
AOM: Acute Otitis Media; CSOM: Chronic Suppurative Otitis Media; HI: Hearing Impairment.
Figure 3
Figure 3. AOM incidence rate estimates for the year 2005 per hundred people, by the 21 WHO regions.
Figure 4
Figure 4. CSOM incidence rate estimates for the year 2005 per thousand people, by the 21 WHO regions.
Figure 5
Figure 5. OM-associated HI (>25 dB for best ear) prevalence rate estimates for the year 2005 per ten thousand people, by the 21 WHO regions.
Figure 6
Figure 6. OM-associated mortality estimates for the year 2005 per ten million people, by the 21 WHO regions.

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    1. Klein JO. The burden of otitis media. Vaccine. 2000;19(Suppl 1):S2–S8. - PubMed
    1. Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989;160:83–94. - PubMed
    1. Vergison A, Dagan R, Arguedas A, Bonhoeffer J, Cohen R, et al. Otitis media and its consequences: beyond the earache. Lancet Infect Dis. 2010;10:195–203. - PubMed
    1. Casselbrant ML, Mandel EM. Epidemiology. In: Rosenfeld RM, Bluestone CD, editors. Evidence-based otitis media. Hamilton, (ON): BC Decker; 2003. pp. 147–162.
    1. Berman S. Otitis media in developing countries. Pediatrics. 1995;96:126–131. - PubMed