الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Otitis- prone child refers to a child with recurrent acute otitis media with occurrence of three episodes in a 6-month period or four episodes in a 12-month period, 3 years of age children one-third will be otitis-prone.
Most important factor in those children who are otitis-prone is Eustachian tube dysfunction and any obstructing cause as adenoid hypertrophy. Day-care attendance increases the risk of OM when compared to children who stay at home. The use of pacifiers increases the risk of recurrent attacks of AOM. Environmental factors as tobacco smoke, season, lack of breast feeding, younger age group and immature immune system, and possibly genetic factors increase the risk of recurrent attacks of AOM.
Epidemiologic studies showed that by 24 months of age; one in seven children will have experienced over six episodes of AOM.
For infants, breast feeding should be encouraged and pacifier use discouraged. Exposure to tobacco smoke should be eliminated; if caregiver cessation is unrealistic, then smoking should be limited to outside the home. Day-care attendance should be discouraged. If the social situation mandates attendance, then an appropriate facility should be chosen that provides the most hygienic environment, as well as the smallest number of children per classroom, thus minimizing the risk of upper respiratory tract infections. Vaccination plays an important role in the prevention of recurrent AOM. The heptavalent pneumococcal conjugate vaccine is successful in reducing the incidence of OM, including the absolute number of OM episodes, the rate of recurrent AOM, and the need for tympanostomy tubes. Similarly, administration of the influenza vaccine showed a 36% reduction in OM episodes in children attending day care. Many studies have documented that antibiotic prophylaxis is effective in preventing recurrent AOM but if the child fails antibiotic prophylaxis, one proceed to bilateral myringotomies and tympanostomy tubes insertion. Many ways for surgical management of otitis-prone child had been recommended. Tympanostomy tubes insertion is considered the initial and better first-line surgical therapy. Tymanostomy tubes reduce the total time with OM to a greater extent than prophylactic antibiotics. Children who are truly otitis-prone may require multiple sets of grommets; alternatively, longer-lasting T tubes may be placed to avoid repeated procedures. Adenoidectomy reduces the incidence of further recurrent AOM, although it may not be an appropriate procedure for young infants. Performing a concurrent tonsillectomy offers no additional benefit in preventing recurrent AOM.