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Pediatric acute otitis externa: Characteristics and predictors for hospital admission
Maayan Gruber1, Danny Damry2, Nur Ibrahim3
1Department of Otolaryngology, Galilee Medical Center, Nahariya, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Insights
Acute otitis externa (AOE) in children often requires hospitalization, especially with symptoms like ear swelling and fever. Pseudomonas aeruginosa is a common cause, and strains remain sensitive to ciprofloxacin.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Acute otitis externa (AOE) is a frequent pediatric infection, peaking in summer.
- Bacterial agents are the primary cause of AOE.
- AOE affects the external auditory canal in children and adults.
Purpose of the Study:
- To identify clinical predictors of hospitalization in pediatric AOE patients.
- To investigate the role of bacterial pathogens, particularly Pseudomonas aeruginosa, in severe pediatric AOE cases.
Main Methods:
- Retrospective observational study of pediatric patients (<18 years) with AOE.
- Data collected from emergency department visits between 2011-2018.
- Analysis of factors correlating with hospital admission and pathogen identification.
Main Results:
- 337 children with 344 AOE visits were analyzed; nearly half occurred in summer.
- Hospitalized children showed higher rates of treatment failure, ear canal edema, fever, discharge, and auricular edema.
- Key predictors for hospitalization included auricular edema, otorrhea, significant ear canal narrowing, fever, and prior systemic treatment.
- Pseudomonas aeruginosa was identified in 78% of hospitalized patients' cultures, with all strains sensitive to ciprofloxacin.
Conclusions:
- Specific clinical variables can predict hospitalization in pediatric AOE.
- Pseudomonas aeruginosa plays a significant role in severe pediatric AOE and remains sensitive to ciprofloxacin.
Background:
Acute otitis externa (AOE), is a common infectious disease affecting children and adults. Its peak prevalence is around the summer months, it involves the external auditory canal and in most cases is due to bacterial agents.
Methods:
This is a retrospective observational analytical case-based study involving all consecutive patients under the age of 18 years old presenting with AOE to a pediatric emergency department.
Results:
We collected data from 337 patients under 18 years of age with 344 visits to the Emergency Department, between the years 2011-2018. Nearly half of the visits presented during the summer months. Children were divided into two subgroups: hospitalized and non-hospitalized. Median hospitalization time was 3 days. The hospitalized sub-group had higher rates of failed treatment, as well as higher rates of external ear canal edema, systemic fever, canal discharge and auricular edema. On multivariable analysis the following variables had the strongest correlation for hospital admission: auricular edema (OR 27.98), otorrhea (OR 1.82), narrowing of the ear canal by more than 50% (OR 1.91), fever (OR 2.92), and previous systemic treatment (OR 2.53). Pseudomonas aeruginosa (PA) was isolated in 78% of cultures in the hospitalized sub-group. All PA strains were sensitive to ciprofloxacin.
Conclusions:
This study highlights the main clinical variables which may predict hospitalization among children with AOE as well as the dominant role of sensitive strains of PA in the pathogenesis of this condition in children.
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