COMMENTARY

AOM Follow-up: Is Parent Report Enough?

William T. Basco, Jr., MD, MS

Disclosures

October 10, 2016

Re-examination of Acute Otitis Media in Children

Current otitis media treatment guidelines state that observation without antibiotics is an acceptable approach to acute otitis media (AOM) in children, but these children should be followed closely to determine whether antibiotics are subsequently necessary.

In a recent study, Uitti and colleagues[1] posed the question of whether re-examination with otoscopy was required to assess worsening of a child's AOM, or whether parental report of symptoms can be relied upon to indicate which children might need re-examination.

This study reported on the outcomes of 158 children who did not receive antimicrobials after a diagnosis of AOM. The children (who were part of a larger trial[2] evaluating active treatment versus placebo for AOM) were aged 6-35 months at the time of diagnosis. The children were re-examined at 48-72 hours and again at 1 week after the diagnosis of AOM. At each visit, the parents reported the child's symptoms and their overall perception of whether the child was healthy, better, had no improvement, or had gotten worse.

At the 48- to 72-hour follow-up visit, the condition of 104 children had improved overall and had not worsened by the final visit at 1 week. The label of "symptomatic failure" was applied to 54 children who, based on parental report, showed no improvement in symptoms or had deteriorated by the time of the 1-week evaluation. Examination findings among the 104 children who had symptomatic improvement revealed that 82.7% showed improvement or resolution of their middle ear findings on examination, 14.4% showed no improvement, and 2.9% developed worse findings. Among the 54 children whose symptoms were reported to have worsened over the evaluation period, 29.6% showed worse physical findings on examination, 48.1% demonstrated no improvement, and 22.2% demonstrated improvement or resolution of tympanic membrane findings. The odds ratio for worsening physical findings among the children with symptomatic improvement was 0.07 (95% confidence interval, 0.02-0.26).

The authors concluded that tympanic membrane findings are related to parent report of symptoms. Only 3% of the children of parents who reported improved clinical symptoms were found to have worse otoscopic findings on re-examination.

Viewpoint

This is a very brief report, but the study evaluates an excellent clinical question. I wish that more children were involved so that we would have more data on any infrequent outcomes before adapting this practice wholesale. Nevertheless, the correlation of improved symptom reports and improved tympanic membrane exam findings is very strong in this population, suggesting that assessment at 2-3 days could include a parental report of symptoms without actual examination.

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