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The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study
Katherine B Gibney1, Peter S Morris, Jonathan R Carapetis
1Department of Medicine, Royal Darwin Hospital, Australia. katherinegibney@hotmail.com
Insights
Acute otitis media (AOM) in Aboriginal children is often painless and persistent, linked to ongoing nasopharyngeal bacterial colonization. Antibiotic benefits appear modest, necessitating careful follow-up and examination for effective treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Acute otitis media (AOM) outcomes vary, particularly in high-risk populations.
- Understanding AOM's clinical course and associated bacterial colonization is crucial for effective management.
Purpose of the Study:
- To describe the clinical course of AOM in Australian Aboriginal children.
- To investigate bacterial nasopharyngeal colonization patterns in this high-risk group.
Main Methods:
- Prospective study of 31 Aboriginal children under eight with AOM.
- Regular otoscopic examinations and tympanometry over 2-3 weeks.
- Weekly nasopharyngeal swabs for bacterial culture.
Main Results:
- AOM in this cohort was typically painless and persistent, with most children showing signs at 7 and 14 days.
- Common nasopharyngeal bacteria included Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Perforations were small, healing and re-perforation were frequent, and antibiotic benefits were minimal.
Conclusions:
- Painless, persistent AOM is characteristic in this high-risk population.
- Persistent bacterial colonization of the nasopharynx is strongly associated with AOM.
- Systematic follow-up and careful clinical assessment are essential for managing AOM in these children.
Background:
It is unclear why some children with acute otitis media (AOM) have poor outcomes. Our aim was to describe the clinical course of AOM and the associated bacterial nasopharyngeal colonisation in a high-risk population of Australian Aboriginal children.
Methods:
We examined Aboriginal children younger than eight years who had a clinical diagnosis of AOM. Pneumatic otoscopy and video-otoscopy of the tympanic membrane (TM) and tympanometry was done every weekday if possible. We followed children for either two weeks (AOM without perforation), or three weeks (AOM with perforation), or for longer periods if the infection persisted. Nasopharyngeal swabs were taken at study entry and then weekly.
Results:
We enrolled 31 children and conducted a total of 219 assessments. Most children had bulging of the TM or recent middle ear discharge at diagnosis. Persistent signs of suppurative OM (without ear pain) were present in most children 7 days (23/30, 77%), and 14 days (20/26, 77%) later. Episodes of AOM did not usually have a sudden onset or short duration. Six of the 14 children with fresh discharge in their ear canal had an intact or functionally intact TM. Perforation size generally remained very small (<2% of the TM). Healing followed by re-perforation was common. Ninety-three nasophyngeal swabs were taken. Most swabs cultured Streptococcus pneumoniae (82%), Haemophilus influenzae (71%), and Moraxella catarrhalis (95%); 63% of swabs cultured all three pathogens.
Conclusion:
In this high-risk population, AOM was generally painless and persistent. These infections were associated with persistent bacterial colonisation of the nasopharynx and any benefits of antibiotics were modest at best. Systematic follow up with careful examination and review of treatment are required and clinical resolution cannot be assumed.
