Introduction and background

Otitis media and sinusitis are among the most common minor bacterial infections affecting children with normal immune function. To date, there has been a paucity of systematic study of these infections in immunocompromised hosts in general. However, substantial experience and a limited literature suggest that, in their acute, chronic, and recurrent forms, they also occur commonly in children who are infected with HIV. Although the causes, manifestations, and clinical courses of most episodes of otitis media and sinusitis in HIV-infected children are indistinguishable from those in immunocompetent children, unusually frequent, prolonged, severe, or otherwise problematic episodes, or those caused by unusual or opportunistic pathogens, can be the sentinel expressions of immunodeficiency that should prompt an assessment for HIV infection.

Epidemiology of acute otitis media and sinusitis

Acute otitis media (AOM) is a very common occurrence in immunocompetent children with peak frequency during the first 2 years of life. In addition to young age, risk factors for AOM include male gender, a history of severe or recurrent AOM in sibling(s), early age of first AOM, absence of breast feeding, winter season, race (with high rates among Eskimos and other Native Americans, as well as among Australian aborigines), day-care attendance, lower socioeconomic status, and craniofacial anomalies [1].

There are three controlled studies that describe the relative frequency of AOM among HIV-infected children [2–4].