Understanding RAOM

Recurrent acute otitis media (RAOM) is a distinct subset of otitis media that affects more than 20% of preschool children.

RAOM is defined as 3 or more episodes of acute otitis media within 6 months or 4 or more episodes of acute otitis media within 12 months, with 1 episode occurring recently.

Xylitol, the primary ingredient in XYLAREX, has been shown to decrease the total number of acute otitis media episodes by 39%. This reduction significantly decreases the number of children experiencing at least 1 episode of acute otitis media. This reduction also reduces the number of antibiotic courses a child is exposed to.

How RAOM Occurs

Research has shown that over-colonization of the upper airways with certain pathogenic bacteria leads to increased rates of otitis media, which is commonly preceded by an upper respiratory infection. The 3 major pathogens that colonize in the upper airways are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

While the exact pathophysiology of RAOM is not fully understood, it is believed that some children fail to develop broad protection against these pathogens, making them more susceptible to RAOM. Normally a healthy balance of the upper airway microflora helps to protect against repeated episodes of pathogenic colonization. Children who experience RAOM have been shown to have an imbalance of the bacteria in their upper airway, resulting in an increased rate of otitis media.

The primary ingredient in XYLAREX helps to maintain a normal balance of healthy upper airway microflora.

Risk Factors

There are many reasons, both host and environment related, why young children are more predisposed to experiencing otitis media than older children and adults.

An important host-related reason is the nature of underdeveloped Eustachian tubes. The Eustachian tubes are the primary pathways pathogens use to travel from the upper airway to the middle ear and function to equalize the air pressure on both sides of the eardrum. Generally speaking, children begin life having shorter, more horizontal Eustachian tubes. As they develop physically, the Eustachian tubes become longer, and their anatomical position becomes more vertical. As the Eustachian tubes become more vertical, it becomes more difficult for disease-causing pathogens to travel from the upper airway to the middle ear.

It is believed that younger children, having relatively shorter and more horizontal Eustachian tubes, provide an easier path of migration for harmful pathogens to travel from the upper airway to the middle ear.

The primary environmental risk factor is daycare attendance. One hypothesis is that daycare attendance increases the exposure to a multitude of viral and bacterial pathogens, resulting in more frequent infections, including otitis media. In fact, recent reports state that transmissions of antibiotic-resistant pathogens in the daycare setting are associated with antibiotic-resistant organisms. These findings suggest the increase in RAOM may be associated with these resistant pathogens. Daycare may also result in earlier acquisition of particular pathogens, which increases the risk of OM transitioning to RAOM.

Other common risk factors are listed below:

Host related risk factors include (but are not limited to): Age Prematurity of birth Gender Race Allergy Immunocompetence Craniofacial abnormalities Genetic predisposition

Environmental risk factors include (but are not limited to): Upper respiratory tract infections Season Daycare exposure Sibling exposure Passive smoking Bottle feeding with formula Socioeconomic status Pacifier use