What is the role of respiratory syncytial virus (RSV) in the etiology of acute otitis media (AOM)?

Updated: Sep 25, 2019
  • Author: John D Donaldson, MD, FRCSC, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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RSV is a large RNA paramyxovirus that is most commonly associated with bronchiolitis and pneumonia in very young persons, though it may cause acute respiratory disease in persons of any age group. [7, 8, 9] In northern climates, RSV is normally identified during annual epidemics in the winter and early spring, but it should be considered in any neonate with lethargy, irritability, or apnea, with or without otitis media. In older infants and children, respiratory symptoms are usually more prominent, making diagnosis easier.

RSV was identified early as a pathogen that appeared to create long-term pulmonary complications, primarily asthma, in as many as half of infants with bronchiolitis. RSV may be particularly lethal for children with congenital heart disease, cystic fibrosis, immunodeficiency, bronchopulmonary dysplasia, or prematurity of less than 37 weeks’ gestational age.

RSV-specific intravenous (IV) immunoglobulin prophylaxis is recommended only for high-risk children. When treating a child with concomitant pneumonia or other systemic disease and otitis media, the practitioner must ensure appropriate diagnosis and management of all aspects of the child’s illness. Drainage of the ear by tympanocentesis or myringotomy for culture and therapy may be necessary in some cases. Drainage is mandatory in neonates who are suspected to be in a septic state or in children who are immunosuppressed.

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