Post-Pandemic Rates of Acute Otitis Media and Tympanostomy Tube Placement

Introduction: The COVID-19 pandemic significantly disrupted typical early-life pathogen exposure patterns, altering children's immune development. During the pandemic, AOM and TTP rates decreased likely due to social distancing measures such as closures of school and childcare facilities. Have rates normalized since then? Did vaccination rates, specifically PCV vaccines, play a role?

Methods: Using the TriNetX database, patients 17 years or younger with CPT codes between 2010 and 2025 for evaluation and management were queried. Monthly rates of AOM, TTP, and PCV-13/15/20 vaccinations were extracted. Mann-Whitney U tests compared trends pre-pandemic (2010–2019) versus post-pandemic (2021–2025).

Results: 15,721,701 pediatric patients were identified, with a mean age of 6.7 years (SD=5.8). 7,604,805 (48%) were female and 8,109,357 (52%) were male. Comparing end data points pre-pandemic (Feb 2020) to post-pandemic (April 2025), AOM rates increased by 150%, from 256 to 640 per 100,000 patients. Concurrently, TTP exhibited a 159% increase, rising from 32 to 83 cases per 100,000 patients. A sudden jump in incidence of AOM and TTP was observed since January 2025. This surge occurred despite a consistent increase in overall PCV vaccination rates.

Conclusions: The abrupt post-pandemic surge in AOM incidence and TTP is likely explained by the "immune debt" hypothesis. Consistent PCV vaccination rates during this period suggest that the escalating incidence is primarily driven by non-vaccine serotypes or viral co-infections. Despite a post-pandemic increase to similar pre-pandemic rates, there was an unexplained upswing in AOM and TTP rates from January to April 2025. Considering this distinctive change in pattern and the limitations of data availability, further exploration is necessary.