Systems perspectives on pediatric otitis media: environmental exposures, genetic susceptibility, and biomarker-guided interventions

Background: Pediatric otitis media remains one of the most common childhood diseases worldwide and is a major cause of hearing impairment, recurrent healthcare utilization, and antibiotic exposure. Its pathogenesis is highly heterogeneous and can no longer be adequately explained by a traditional single-pathogen model. Objective: This review aims to synthesize current evidence on the roles of environmental exposures, host genetic susceptibility, biomarkers, and microbial factors in pediatric otitis media, with particular emphasis on their interactions and translational relevance. Content: Current evidence suggests that early-life environmental exposures may contribute to pediatric otitis media through convergent pathways involving epithelial dysfunction, impaired mucociliary clearance, inflammation, oxidative stress, and altered immune regulation, while host genetic variation may further modify susceptibility and disease heterogeneity. Emerging biomarker and microbial studies also support a systems-level understanding of pediatric otitis media and its therapeutic complexity. Conclusion: Pediatric otitis media should be understood as a multifactorial disorder arising from dynamic interactions among environmental exposures, host susceptibility, and microbial ecology. This integrated framework extends beyond pathogen-centered models and provides a conceptual basis for future biomarker validation, mechanistic stratification, and the development of more precise preventive and therapeutic strategies.