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Acute otitis media: who needs posttreatment follow-up?
T J Hathaway1, H P Katz, R A Dershewitz
1Department of Pediatrics, Harvard Community Health Plan, Braintree, MA 02184.
Insights
Parental assessment of ear infection resolution and symptom presence accurately predicts outcomes in acute otitis media (AOM). Selective follow-up is recommended for high-risk children or those with persistent symptoms.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Optimal follow-up timing for acute otitis media (AOM) remains undefined.
- Clinician recommendations for AOM follow-up vary significantly.
Purpose of the Study:
- To identify risk factors and symptoms predicting AOM resolution, recurrence, or persistence post-treatment.
- To inform evidence-based strategies for AOM follow-up care.
Main Methods:
- Prospective study of 304 children (6 months-4 years) diagnosed with AOM.
- Data collection via questionnaires on risk factors, symptoms, and parental observations at diagnosis and 10-21 day follow-up.
- Clinical assessment of AOM outcome (resolved or persistent) at follow-up.
Main Results:
- 24.9% of patients had persistent AOM at 10-21 day follow-up.
- Parental impression of resolution and absence of symptoms accurately identified 97.1% of resolved cases.
- Increased risk of persistent AOM was associated with age ≤15 months and sibling history of recurrent AOM.
Conclusions:
- Parental judgment and symptom observation are reliable indicators of AOM resolution.
- A selective follow-up strategy is proposed for children with unresolved symptoms, parental concerns, or higher-risk factors (age ≤15 months, family history).
Objective:
Because the optimal timing for follow-up of acute otitis media (AOM) is unknown and clinicians' recommendations for timing follow-up are highly variable, a study was conducted to determine which risk factors or symptoms could predict the resolution, recurrence, or persistence of AOM after treatment completion.
Methods:
Three hundred four children from a general pediatric practice in a staff-model health maintenance organization, ages 6 months to 4 years diagnosed with AOM were enrolled in a prospective study of the clinical outcome of AOM at 10 to 21 days from diagnosis. Risk factors, symptoms, and parental observations were obtained by questionnaire at both the initial and follow-up visit 10 to 21 days later. At the follow-up visit, the clinical outcome of resolved AOM or persisting AOM was determined by the examining clinician.
Results:
One hundred eighty-one patients returned for follow-up between 10 to 21 days; 24.9% had AOM at follow-up. Parental impression of resolved ear infection and the absence of symptoms at follow-up identified 97.1% of children with resolved AOM. Other factors associated with increased risk of AOM at follow-up were age < or = 15 months and a family history of recurrent AOM in a sibling.
Conclusions:
Because parental judgement of ear status and observation of symptoms appear to accurately identify those children with resolved AOM, a follow-up strategy is proposed in which posttreatment follow-up may be selectively offered to children whose parent(s) feels the infection has not resolved, children whose symptoms persist, or children at higher risk for AOM such as those < or = 15 months or with a family history of recurrent otitis.