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Can acute otitis media caused by Haemophilus influenzae be distinguished from that caused by Streptococcus

Eugene Leibovitz1, Robert Satran, Lolita Piglansky

  • 1Pediatric Infectious Disease Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

The Pediatric Infectious Disease Journal
|June 12, 2003
PubMed
Abstract

Insights

Acute otitis media (AOM) in infants is more severe when bacterial cultures are positive. Tympanic membrane redness and bulging best indicate bacterial infection, but a clinical score cannot differentiate between specific bacterial causes.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Otolaryngology

Background:

  • Limited data suggest Streptococcus pneumoniae causes more severe acute otitis media (AOM) than Haemophilus influenzae or Moraxella catarrhalis.
  • Severity is assessed by tympanic membrane and systemic findings.

Purpose of the Study:

  • To evaluate AOM severity and pathogen impact using a comprehensive clinical/otologic score.
  • To assess the influence of age, disease history, and prior antibiotic therapy on AOM severity.

Main Methods:

  • A clinical/otologic score (0-15) evaluated tympanic membrane redness/bulging, fever, irritability, and ear tugging in 372 children (3-36 months) with AOM.
  • Tympanocentesis and middle ear fluid culture were performed at enrollment.

Main Results:

  • Culture-positive AOM had higher clinical/otologic scores (9.27) than culture-negative (8.38), particularly in infants aged 3-6 months.
  • Tympanic membrane redness and bulging scores were higher in bacterial AOM, indicating bacterial etiology.
  • No significant differences in clinical/otologic scores were found between different bacterial pathogens (H. influenzae, S. pneumoniae) or in relation to prior antibiotic treatment or AOM history.

Conclusions:

  • Culture-positive AOM in young infants presents with higher severity scores than culture-negative cases.
  • Tympanic membrane redness and bulging are key indicators of bacterial AOM.
  • A clinical/otologic score cannot differentiate between specific bacterial causes of AOM.

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