Use of symptoms and risk factors to predict acute otitis media in infants

Abstract

Objectives Infants and children with upper respiratory tract infection (URI) often have concurrent acute otitis media (AOM). Young infants have less specific symptoms than older children. The purpose of this study was to evaluate the usefulness of symptoms and other risk factors in predicting the presence of AOM in infants. Methods Healthy infants, age ≤ four weeks, were enrolled and followed prospectively for up to age one year. Infants were scheduled for a research visit when their parents noted the onset of symptoms. At each URI visit, parents first reported the severity of symptoms. An investigator then diagnosed the presence or absence of concurrent AOM. Risk factors and symptom scores for infants with and without AOM were studied. Results Infants (N=193, mean age at first URI 3.9 ± 2.5 months) experienced 360 URI episodes and 63 AOM events. Symptoms consisting of fever, earache, poor feeding, restless sleep, and irritability together (ETG-5) were statistically associated with the prediction of AOM (P=0.006). A multiple variable statistical model (J-Score) that included day care attendance, age, severity of cough and earache best predicted AOM (P < 0.001), with 95% specificity. Both ETG-5 and J-score yielded relatively low sensitivity for AOM prediction. Conclusions : In infants with URI in the first year of life, severity of symptoms was significantly associated with concurrent AOM. Daycare attendance, presence and severity of earache and cough added to better correlation. These observations may have clinical application in identification of infants at risk for AOM.

Acute otitis media symptoms and symptom scales in research with Aboriginal and Torres Strait Islander children

“…The criteria for an AOM diagnosis which determined recruitment to the WATCH trial was bulging of the tympanic membrane and/or ear pain (or irritability in children under 3 years). This accords with Australian guidelines and is congruent with the trend to de-emphasise symptoms in the diagnosis of AOM [ 1 , 12 , 21 ]. However debate continues and it is common for guidelines and research protocols to include recent onset of symptoms in the diagnosis of AOM [ 20 – 22 ].…”

“…In a study of children younger than 12 months with upper respiratory tract infections, higher scores of parental-reported symptoms (fever, earache, poor feeding, restless sleep, and irritability) were statistically associated with the prediction of AOM. However, these symptoms were most predictive of AOM when combined with reports of cough, severe ear pain, and the AOM risk factor of day care attendance [ 21 ].…”

“…Research and clinical management of AOM is complicated by the fact that different diagnostic criteria for AOM may be applied internationally [20][21][22]. The criteria for an AOM diagnosis which determined recruitment to the WATCH trial was bulging of the tympanic membrane and/or ear pain (or irritability in children under 3 years).…”

Otitis Media in Fully Vaccinated Preschool Children in the Pneumococcal Conjugate Vaccine Era

“… 52 , 53 , 56 Contrary to previously reported association of fever with bacterial AOM, our study found that fever is more commonly associated with OME than with t-AOM. 54 , 57 So, fever by itself, in a fully vaccinated child, even at the age less than 2 years, should not point toward a diagnosis of bacterial infection, and otoscopic findings should be used to diagnose AOM and guide the use of antibiotics. 58 , 59 …”

“…52,53,56 Contrary to previously reported association of fever with bacterial AOM, our study found that fever is more commonly associated with OME than with t-AOM. 54,57 So, fever by itself, in a fully vaccinated child, even at the age less than 2 years, should not point toward a diagnosis of bacterial infection, and otoscopic findings should be used to diagnose AOM and guide the use of antibiotics. 58,59 Majority of our patients with OM were treated with antibiotics, despite physicians' awareness about the evidenced-based AAP recommendations to restrict antibiotic use for the treatment of AOM.…”