The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study

Abstract

BackgroundIt is unclear why some children with acute otitis media (AOM) have poor outcomes. Our aim was to describe the clinical course of AOM and the associated bacterial nasopharyngeal colonisation in a high-risk population of Australian Aboriginal children.MethodsWe examined Aboriginal children younger than eight years who had a clinical diagnosis of AOM. Pneumatic otoscopy and video-otoscopy of the tympanic membrane (TM) and tympanometry was done every weekday if possible. We followed children for either two weeks (AOM without perforation), or three weeks (AOM with perforation), or for longer periods if the infection persisted. Nasopharyngeal swabs were taken at study entry and then weekly.ResultsWe enrolled 31 children and conducted a total of 219 assessments. Most children had bulging of the TM or recent middle ear discharge at diagnosis. Persistent signs of suppurative OM (without ear pain) were present in most children 7 days (23/30, 77%), and 14 days (20/26, 77%) later. Episodes of AOM did not usually have a sudden onset or short duration. Six of the 14 children with fresh discharge in their ear canal had an intact or functionally intact TM. Perforation size generally remained very small (<2% of the TM). Healing followed by re-perforation was common. Ninety-three nasophyngeal swabs were taken. Most swabs cultured Streptococcus pneumoniae (82%), Haemophilus influenzae (71%), and Moraxella catarrhalis (95%); 63% of swabs cultured all three pathogens.ConclusionIn this high-risk population, AOM was generally painless and persistent. These infections were associated with persistent bacterial colonisation of the nasopharynx and any benefits of antibiotics were modest at best. Systematic follow up with careful examination and review of treatment are required and clinical resolution cannot be assumed.

Absent otoacoustic emissions predict otitis media in young Aboriginal children: A birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia

“…In view of the infrequent assessments of middle ear status, we were unable to follow the natural history of the disease and determine whether the hearing loss and presence of middle ear effusions were continuous or intermittent, as has been described elsewhere [32]. …”

A review of the burden of disease due to otitis media in the Asia-Pacific

“…Compared to non-Aboriginal children, OM in Aboriginal children begins very early in life, is frequently bilateral and is less likely to resolve spontaneously, establishing within the first year of life a pattern of chronic persisting disease [13,[20][21][22]. By the age of 6 months, 14% of children have experienced TM perforation, increasing to 40% by 18 months of age [23].…”

Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross-sectional survey

“…Episodes of severe otitis media were most often associated with infection with one or more types of Streptococcus pneumoniae or Haemophilus influenzae (and frequently both). At the time of this survey, infection with penicillin resistant pneumococci and treatment failure were common [11]. …”