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RSV infection complicated by acute otitis media in 27.7% of children under 5RSV infection often leads to middle ear infections in children

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Key Takeaway
Consider RSV as a common trigger for AOM in young children, with bacterial co-infection frequent.

This meta-analysis synthesizes data on the relationship between respiratory syncytial virus (RSV) infection and acute otitis media (AOM) in children aged 0-60 months. The primary outcome was the proportion of RSV infections complicated by AOM, estimated at 27.7% (95% CI 12.4-50.7). Secondary analyses found RSV detected in 23.6% of AOM-associated samples (95% CI 14.8-35.5), with higher detection in nasopharyngeal (22.2%) than middle ear fluid (18.8%). Bacterial co-infections were present in 70.1% of RSV-positive middle ear fluid samples from children with AOM (95% CI 43.4-87.7). Factors associated with AOM development in RSV-positive children included high viral load, Streptococcus pneumoniae co-infection, age 3-12 months, and fever.

The authors note significant heterogeneity and methodological differences across studies, limiting the accuracy and generalisability of findings. The review underscores RSV as a prominent viral contributor to AOM pathogenesis, but the association is observational. Practice relevance is tempered by the wide confidence intervals and variability in study designs.

How this fits prior evidence

This meta-analysis quantifies the RSV-AOM link, extending prior coverage that highlighted RSV co-infections and severity (Apr 2026 narrative review). The 27.7% complication rate and 23.6% RSV detection in AOM provide pooled estimates, whereas prior items focused on hospitalization (Dec 2026, May 2026) or general co-infection patterns. The high bacterial co-infection rate (70.1%) aligns with the Apr 2026 review's emphasis on co-infections and severity.

When a child catches the respiratory syncytial virus (RSV), it can do more than just cause a cough. This common virus often leads to complications in the ears. Researchers found that about 27.7% of children with RSV infections also developed acute otitis media, which is a middle ear infection.

This study looked at children under two years old. The data shows that when these children do develop an ear infection involving RSV, they have a high chance of having a bacterial co-infection as well. Specifically, about 70.1% of those cases involved bacteria growing alongside the virus in the middle ear fluid.

Certain factors make this risk higher for some kids. Children between 3 and 12 months old are more likely to develop these ear infections. Other factors include a high viral load, having a fever, or a co-infection with Streptococcus pneumoniae. Because of differences in how various studies were conducted, the exact scale of these risks can vary.

What this means for you:
About 28% of children with RSV will develop a middle ear infection, often involving bacteria.

Common questions

How common is it for RSV to cause an ear infection?

About 27.7% of children with a respiratory syncytial virus (RSV) infection also develop acute otitis media, which is a middle ear infection.

Can bacteria be involved when RSV causes an ear infection?

Yes, the data shows that 70.1% of children who had both RSV and a middle ear infection also had bacterial co-infections in their middle ear fluid.

Are some children at higher risk for these complications?

Children between 3 and 12 months old are at higher risk. Other factors associated with developing a middle ear infection include a high viral load, fever, and co-infection with Streptococcus pneumoniae.

Study Details

Study typeMeta analysis
EvidenceLevel 1
Follow-up60.0 mo
PublishedJun 2026
View Original Abstract ↓
BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of infant respiratory infections and an important contributor to acute otitis media (AOM) development. We aimed to synthesise evidence on RSV-associated AOM to support research to reduce its morbidity. METHODS: In April 2025, we performed a systematic review and meta-analysis by searching the Embase, MEDLINE, and Global Health databases to identify studies reporting RSV-associated AOM in children aged 0-60 months. We extracted the proportions of RSV infections complicated by AOM, the proportions of AOM-associated samples with RSV detected, and the odds ratios for factors associated with AOM development in RSV-positive children. RESULTS: Pooled estimates revealed 27.7% (95% confidence interval (CI) = 12.4-50.7) of RSV infections were complicated by AOM. RSV was detected in 23.6% (95% CI = 14.8-35.5) of AOM-associated samples, with detection rates slightly higher in nasopharyngeal samples 22.2% (95% CI = 13.2-34.8) than middle ear fluid samples 18.8% (95% CI = 6.6-42.9). Bacterial co-infections were present in 70.1% (95% CI = 43.4-87.7) of RSV-positive middle ear fluid samples among children with AOM. Factors associated with AOM development in RSV-positive children included high viral load, Streptococcus pneumoniae co-infection, being aged between 3 and 12 months, and fever. CONCLUSIONS: RSV is a prominent viral contributor to AOM pathogenesis; however, significant heterogeneity and methodological differences across studies limit the accuracy and generalisability of findings. Standardised prospective studies are needed to further investigate risk stratification and evaluate the effectiveness of interventions to prevent RSV-associated AOM and improve its management. REGISTRATION: PROSPERO: CRD42025642807.
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