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Although OM is a multifactorial disease involving Eustachian tube (ET) dysfunction, allergy, upper respiratory infection, and various environmental factors, the primary cause is bacterial infection of the middle ear (ME) mainly by Streptococcus pneumoniae , non-typeable Haemophilus influenzae (NTHi), or Moraxella catarrhalis 4

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We should say that one of the Skaflestads probably got Matts quarry, since its pretty well known that the Browns dont do any actual hunting on the show

Highlight any significant variations across different age groups, genders, and regions