Why Otitis Media Can Be Recurrent?

Recurrent acute otitis media (more than three episodes within 6 months or four episodes within 12 months) is generally due to relapse or reinfection, although data indicate that the majority of early recurrences are new infections. In general, the same pathogens responsible for acute otitis media cause recurrent disease; even so, the recommended treatment consists of antibiotics active against ß-lactamase-producing organisms. Antibiotic prophylaxis for patients with recurrent acute otitis media [e.g., with trimethoprim-sulfamethoxazole (TMP-SMX) or amoxicillin] can reduce recurrences by an average of one episode per year, but this benefit is small compared with the cost of the drug and the high likelihood of colonization with antibiotic-resistant pathogens. Other approaches, including placement of tympanostomy tubes, adenoidectomy, and tonsillectomy plus adenoidectomy, are of questionable overall value, given the relatively small benefit compared with the potential for complications.

Source: Harrison_s_Principles_of_Internal_Medicine_16th_Edition