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Ear discharge in children presenting with acute otitis media: observational study from UK general practice

Lindsay Smith1, Paul Ewings, Caroline Smith

  • 1East Somerset Research Consortium, Westlake Surgery, West Coker, Somerset. research@esrec.nhs.uk

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|February 6, 2010
PubMed

Insights

Children with acute otitis media presenting with ear discharge are sicker and may face worse outcomes. This finding supports current guidelines recommending antibiotics for acute otitis media with ear discharge.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Practice Guidelines

Background:

  • Current National Institute for Health and Clinical Excellence (NICE) guidelines for treating otitis media in children recommend antibiotics only for cases with ear discharge, based on limited evidence.
  • The clinical significance and outcomes associated with ear discharge in acute otitis media require further investigation in routine practice.

Purpose of the Study:

  • To evaluate the clinical significance of ear discharge in children diagnosed with acute otitis media.
  • To determine the outcomes for children with acute otitis media who present with ear discharge in a primary care setting.

Main Methods:

  • An observational cohort study was conducted involving 256 children aged 6 months to 10 years presenting with acute otitis media in primary care.
  • Children were categorized based on the presence or absence of ear discharge at presentation.
  • Clinical features were recorded, and follow-up assessments were performed at 2 weeks and 3 months.

Main Results:

  • Children with ear discharge were significantly more likely to receive antibiotics (adjusted odds ratio 15).
  • A majority of children with ear discharge had confirmed bacterial infections (58%) and presented with more severe systemic illness, indicated by higher temperature, pulse rate, and Yale score.
  • Ear discharge was associated with an increased likelihood of adverse outcomes, including pain at 1 week, recurrent acute otitis media, and hearing difficulties at 3 months.

Conclusions:

  • Ear discharge in children with acute otitis media identifies a subgroup that is systemically sicker and at a higher risk for adverse outcomes.
  • The findings support the existing NICE guidance recommending antibiotic treatment for acute otitis media when ear discharge is present.
Abstract

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