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Prognosis of acute otitis media: factors associated with poor outcome
J Jero1, A Virolainen, M Virtanen
1Department of Otolaryngology, Helsinki University Central Hospital, Finland.
Insights
Young children with acute otitis media (AOM) face higher risks of treatment failure and persistent middle ear fluid. Factors like allergies and prolonged earache also indicate poor outcomes in AOM cases.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Understanding factors predicting poor AOM outcomes is crucial for effective management.
- Previous studies have identified various risk factors, but comprehensive analysis is needed.
Purpose of the Study:
- To identify factors associated with poor outcomes in children with acute otitis media.
- To differentiate between clinical failure and persistent middle ear effusion (MEE).
- To inform clinical practice and improve AOM management strategies.
Main Methods:
- Retrospective analysis of 131 children aged 1/4 to 7 1/2 years with AOM.
- Multivariate analysis to identify predictors of clinical failure and persistent MEE.
- Assessment of variables including age, allergy history, earache duration, and microbial findings.
Main Results:
- Overall, 28% of children experienced poor AOM outcomes.
- Clinical failure occurred in 12% of cases, associated with younger age (<2 years), allergy history, prolonged earache (>6h), and Moraxella catarrhalis.
- Persistent MEE (>1 month) was linked to younger age, otitis proneness, bilateral AOM, and Streptococcus pneumoniae in univariate analysis.
Conclusions:
- Younger age (<2 years) is a significant predictor for both clinical failure and persistent MEE in AOM.
- Specific bacterial presence and symptom duration are critical factors influencing treatment success.
- Further research into otitis proneness and bilateral AOM impact is warranted.
Abstract:
Factors associated with poor outcome of acute otitis media (AOM) were analysed in 131 children aged 1/4 to 7 1/2 (median 2 1/2) years. After AOM, altogether 37 (28%) of the children had poor outcome: 15 children (12%) clinical failure (unimprovement or worsening of pre-treatment signs and symptoms within 2 weeks of onset of therapy) and 31 (24%) persistent middle ear effusion (MEE) > or = 1 month post-treatment. Of the different variables studied in multivariate analysis, age < 2 years (p < 0.01), history of allergic skin or respiratory symptoms (p = 0.02), > or = 6 h duration of pre-treatment earache (p = 0.01) and B. catarrhalis in MEE (p = 0.05) were associated with clinical failure. Children with previous adenotomy or unilateral AOM had no failures. Persistence of MEE at 1 month was associated with age < 2 years (p = 0.05), otitis proneness (p = 0.03), bilaterality of AOM (p < 0.01) and S. pneumoniae in MEE (p = 0.01) in univariate but not in multivariate analysis.