Multiple factors play a role in the development of AOM. Viral infection of the nasopharynx impairs eustachian tube function and causes mucosal inflammation, impairing mucociliary clearance and promoting bacterial proliferation and infection. Children are predisposed to AOM because their eustachian tubes are shorter, more flaccid, and more horizontal than adults, which make them less functional for drainage and protection of the middle ear from bacterial entry.5 Clinical signs and symptoms of AOM are the result of host immune response and cellular damage caused by inflammatory mediators such as tumor necrosis factor and interleukins that are released from bacteria.3

Viscous middle ear effusions caused by allergy or irritant exposure may contribute to impaired mucociliary clearance and AOM in susceptible individuals. OME occurs chronically in atopic children, and effusion can persist for months after an episode of AOM. Children with chronic OME usually require tympanostomy tube placement to reduce complications such as hearing and speech impairment and recurrent otitis media.

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