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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

Due to lockdowns and declining demand from cigarette manufacturing sectors, which are the significant customers of cigarette paper, COVID-19 has also affected the market for cigarette paper

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However, his celebrity masked his use of marijuana and laxatives to deal with his often-complicated anxieties