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.

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 siblings, early age of first AOM, absence of breast feeding, winter season, race (with high rates among Eskimos and other Native Americans, as well as Australian aborigines), daycare 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]. All clearly indicate that, although this common childhood condition does not affect a greater proportion of children infected with HIV than normal children, it does recur significantly more often among children with symptomatic HIV infection.

Acute sinusitis is an extremely common problem among young children with normal immunity. It has been estimated that 5%–10% of viral upper respiratory infections (URIs) in young children (which occur six to eight times annually) are complicated by bacterial sinusitis [5].