A pediatric nurse is assessing a child with otitis media that has frequent ear problems. The nurse recognizes that which of the following risk factors are associated with otitis media?

A. Using cotton-tipped swabs can push earwax deeper into the ear canal, increasing the risk of infection and otitis media. B. Frequent viral infections may contribute to upper respiratory issues, but they are not the primary risk factor for otitis media. C. Playing in the pool is a potential risk for outer ear infections, not otitis media. D. Cleaning the ears with vinegar is not associated with an increased risk of otitis media.