Acute infections of the middle ear are met with at all times, but from December to April of each year they are exceedingly numerous, and as surely as they appear in succeeding years they vary in symptomatology and severity. In the past season, for instance, the number of cases of acute otitis media was greater than usual, and the severity of the symptoms was out of proportion to the morbidity of the disease.
It is indeed surprising how seldom aural examinations are practiced routinely; and it is well to emphasize at the beginning that, when such an examination is made and reveals trouble, and the proper methods of treatment are instituted, we have not only treated the existing condition, but have also applied prophylaxis against permanent loss of function and the dangerous intracranial complications.
Considering the causative factors, we find the most common source of acute middle ear inflammation
A. SPENCER KAUFMAN. A CONSIDERATION OF ACUTE AURAL DISEASE IN CHILDREN. JAMA. 1922;79(3):208–211. doi:10.1001/jama.1922.02640030034010