A variety of host and environmental factors, as well as infectious etiologic agents, have been linked to infection of the middle ear and mastoid. AOM occurs most commonly between 6 and 24 months of age. Subsequently, the incidence of AOM declines with age except for a limited reversal of the downward trend between 5 and 6 years of age, the time of entrance into school. The incidence of uncomplicated AOM is not significantly different in boys from that in girls. Mastoiditis, however, would appear to be more common among males.

Studies of eastern coast American children have demonstrated a higher incidence of middle ear infections in Hispanic and Caucasian children than in black children. The higher incidence of middle ear and mastoid infections in certain peoples is not readily explained. Variability in eustachian tube size, orientation, and function among racial groups has been suggested as being responsible for differences in disease incidence. Genetic predisposition to middle ear infection and associated complications has also been demonstrated. Down syndrome, cleft palate, and other craniofacial anomalies are also associated with a high risk of developing AOM, OME, and CSOM.

The severity of otitic infections is related to factors such as extremes of climate (temperature, humidity, and altitude) and poverty with attendant crowded living conditions, inadequate hygiene, and poor sanitation. There is a well-recognized seasonal variance in the incidence of AOM. During the winter months, outpatient visits for AOM are approximately 4-fold higher than in the summer months. Although intake of mother's milk and avoidance of cigarette smoke appear to confer some protection against OME, no effect on the incidence of suppurative complications has been shown.

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