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

Study design: Cohort (prospective)

Funding: Government

Setting: Outpatient (specialty)

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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Comments

Pieter Richard Verbeek

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.

ARUP KUMAR DHARA

Impact assessment

Very good