Signs and symptoms predicting acute otitis media

T. Heikkinen and O. Ruuskanen
Department of Pediatrics, Turku (Finland) University Hospital.

OBJECTIVE: To determine whether acute otitis media can be distinguished from an uncomplicated upper respiratory tract infection by the symptoms of the children. DESIGN: Prospective cohort study. SETTING: Urban, pediatric primary care center in Turku, Finland. PATIENTS: Three hundred two children younger than 4 years (mean age, 2.1 years) attending day-care centers were followed up and examined during episodes of upper respiratory tract infection. The signs and symptoms of the children were recorded daily by the parents. MAIN RESULTS: The specificity and positive predictive value of earache for acute otitis media were 92% and 83%, respectively. However, 40% of the children with acute otitis media had no apparent earache. Restless sleeping had a specificity of 51% and a positive predictive value of 46% for acute otitis media. Thirty-one percent of the children with acute otitis media had no fever. Continuation of respiratory symptoms for several days after the first examination was significantly related with later development of acute otitis media. CONCLUSIONS: Earache in children with upper respiratory tract infection is indicative of acute otitis media, but the absence of earache does not preclude acute otitis media. Therefore, even in the absence of any signs and symptoms localized to the ear, all children at risk for acute otitis media should be examined during upper respiratory tract infection, and if respiratory symptoms persist for several days after the initial visit, a reexamination should be performed. Restless sleeping and fever are of no value in distinguishing acute otitis media from an uncomplicated upper respiratory tract infection.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Program of Anticipatory Guidance for the Prevention of Emergency Department Visits for Ear Pain
McWilliams et al.
Arch Pediatr Adolesc Med 2008;162:151-156.
ABSTRACT | FULL TEXT  

A randomized, double-blind, placebo-controlled noninferiority trial of amoxicillin for clinically diagnosed acute otitis media in children 6 months to 5 years of age
Le Saux et al.
CMAJ 2005;172:335-341.
ABSTRACT | FULL TEXT  

Tubes and Ear Infections
Powers et al.
Pediatrics 2004;113:178-179.
FULL TEXT  

Bullous Myringitis: A Case-Control Study
McCormick et al.
Pediatrics 2003;112:982-986.
ABSTRACT | FULL TEXT  

Does This Child Have Acute Otitis Media?
Rothman et al.
JAMA 2003;290:1633-1640.
ABSTRACT | FULL TEXT  

Importance of Respiratory Viruses in Acute Otitis Media
Heikkinen and Chonmaitree
Clin. Microbiol. Rev. 2003;16:230-241.
ABSTRACT | FULL TEXT  

Diagnostic Accuracy, Tympanocentesis Training Performance, and Antibiotic Selection by Pediatric Residents in Management of Otitis Media
Pichichero
Pediatrics 2002;110:1064-1070.
ABSTRACT | FULL TEXT  

Assessing Diagnostic Accuracy and Tympanocentesis Skills in the Management of Otitis Media
Pichichero and Poole
Arch Pediatr Adolesc Med 2001;155:1137-1142.
ABSTRACT | FULL TEXT  

Serum Interleukin-6 in Bacterial and Nonbacterial Acute Otitis Media
Heikkinen et al.
Pediatrics 1998;102:296-299.
ABSTRACT | FULL TEXT  

PREDICTING ACUTE OTITIS MEDIA IN CHILDREN
JWatch General 1995;1995:6-6.
FULL TEXT