Otitis media (OM) remains the most common bacterial disease of children with now over a billion cases of acute OM and chronic suppurative OM combined each year. In addition, OM is a highly recurrent disease with associated mortality in the developing world and morbidity globally as the most common cause of hearing loss, an outcome that leads to developmental delays in behavior, language, and education for this vulnerable population. Acute OM is one of the most common indications for outpatient surgery (tympanostomy tube placement) and prescription of antibiotics with staggering treatment costs worldwide. In addition, there are important equity issues in the population-specific variability in OM clinical presentation and burden of disease.

The many diverse direct and indirect costs of OM are compounded by the readily predictable effects of continued high use of antibiotics that are driving potentially catastrophic antibiotic resistance levels in OM pathogens as well as bystander pathogens. A holistic view of the interactions between pathogens and host, informed by mechanistic studies at various levels, should guide our management of these many problems.

Ongoing efforts to reduce and ultimately eliminate OM disease burden can be informed by synthesis of information from public health, clinical diagnosis and treatment, and therapeutic development. For example, improved clinical diagnostics based upon uniform OM definitions and technological advances will better reveal prevalence rates of distinct manifestations and distinguish disease symptoms and pathogens to inform a more accurate accounting of disease burden. Investigations of pathogenic and immunological mechanisms will increase our understanding of OM chronicity. Understanding the development of effective protective immunity to prevent and/or clear infections in the middle ear will guide the development of improved vaccines and therapeutics. In particular, understanding both protective immunity and how it is inhibited by pathogen immunomodulation approaches could identify key targets for interventions.

Areas of expected advances:

· Novel approaches to detect and treat various forms of OM

· Early identification of children at risk for recurrent and chronic OM and predisposing factors

· Role of immune maturation on disease and recurrence

· Components and function of effective immune clearance/protection

· Contribution of biofilms to chronicity

· Pathogen immunomodulation and/or immune evasion

· Integrated ‘omics’ studies to inform molecular mechanisms of disease

· Effects of microbiome of nasopharynx and middle ear on susceptibility/resistance

· Impact of changes in hygiene habits and social distancing on OM prevalence/presentation

· Experimental systems to study the above areas

Article Types: Review articles, Perspectives, clinical and basic Research articles are welcomed.

The aspiration of this Research Topic is to constitute a compilation of the best current research in OM, serve as a primer for those entering the field or single source update for those in the field. Although research articles may be highly detailed in Results, much of the Introduction and Discussion should be written for a broader general scientific audience than is typical for specialized trade journals. Articles will be evaluated based on high standards of significance and rigor, as well as interest, relevance and clarity to a broad scientific, medical and public health audience.

Topic Editor Dr. Pelton received financial support from Merck, Pfizer. He receives a honorarium from Pfizer Inc., Merck Vaccines, Sanofi Pasteur, and Seqirus for advisory board activities, consultation on research, and symposium participation. The other Topic Editors declare no competing interests with regard to the Research Topic subject.

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