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Most recurrences of acute otitis media occur within 10 months
Clinical Question
In children with acute otitis media, what is the window of time in which they will experience, if they will, another episode?
Bottom line
In this small study of the natural history of AOM, 80% of episodes will occur between 6 month and 21 months of age. Significant predictors of subsequent AOM included age at first AOM and daycare attendance. If the children experience one or more additional episodes, 83% will occur within 6 months and 97% within 10 months of the first episode. In other words, there is a window of susceptibility for AOM. The authors speculate that tympanostomy tubes often are placed outside of this window, leading to their general ineffectiveness. 1b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Outpatient (specialty)
Synopsis
These researchers longitudinally followed 286 children, recruited from a single primary care pediatric practice, who had at least 1 diagnosis (range = 1 to 8) of acute otitis media (AOM). Most children were white, most lived in a nonsmoking home, and half attended daycare. More than 85% of the first case and subsequent episodes were confirmed by culture of middle ear contents (it’s easy to see why it took them 11 years to recruit all the children). Given the period of data collection (2006–2017), it’s likely most episodes were treated with an antibiotic. Eighty percent of AOM episodes occurred in children between 6 months and 21 months of age. Children with their first episode occurring early in their life and those in daycare were more likely to have additional infections. Almost all follow-up cases of AOM (97%) occurred within the following 10 months; 83% occurred within 6 months.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
AOM recurrence
So I have to give credit to the perseverance of the investigators in getting this study done. However from a critical appraisal perspective, the study is small, there is a major selection bias, and clinicians are not at all likely to obtain cultures in order to make management decisions. I suppose the study is more about the value of tympanostomy tubes in children in older children. Whether or not this study will raise the threshold for which tubes are considered (or lower the tendency for tubes in children who do not meet the clinical profile of patients in this study) remains to be seen. This study is unlikely to ever be repeated so my sense is that there won't be a significant practice change on the basis of this article.
Impact assessment
Very good