SAN FRANCISCO — Parents may think they know when their child has an acute ear infection, but they don't.
That's the implication of a study of children aged 6–35 months that showed parents' reasons for suspecting acute otitis media (AOM), symptoms, and symptom scores could not differentiate 237 children with AOM from 232 who had respiratory tract infection without AOM. Only when tympanic-membrane examination was added to these clues could the diagnosis be made (Pediatrics 2010;125: e1154-61).
“For me, this study has quite a lot of meaning,” Dr. Ellen R. Wald said at the meeting. “Parental diagnosis of acute otitis media” is not reliable. “We shouldn't let the presence of those historical items persuade us” to accept a presumed diagnosis.
The diagnosis of AOM relies heavily on accurate otoscopy, said Dr. Wald, professor and chair of pediatrics at the University of Wisconsin, Madison.
She did not participate in the Finnish study, in which parents completed structured questionnaires on the occurrence, duration, and severity of symptoms before otoscopic examination of the child.
The reasons that parents thought a child might have an ear infection did not differ significantly between groups. In children with and without AOM, respectively, parental suspicion was raised by restless sleep in 28% and 29%, ear pain in 13% and 9%, ear rubbing in 10% and 18%, severe or prolonged rhinitis or cough in 9% and 7%, and irritability in 17% and 19%.
Fever also did not differentiate between the two groups.
Otoscopy also is essential to differentiate AOM from OM with effusion, Dr. Wald added. AOM results from a bacterial infection, and antibiotic therapy may help. OM with effusion is a sterile, nonbacterial inflammatory state that resolves spontaneously, and antibiotic therapy is neither appropriate nor beneficial. OM with effusion causes hearing loss, which is a confounder for AOM, she said.
Dr. Wald said she has no relevant conflicts of interest.