A number of viruses and bacteria ar...

A number of viruses and bacteria are established pathogens in acute otitis media (AOM). one of these organisms have reported associations with different clinical signs and symptoms. Palmu and colleagues from the Finnish Otitis Media Vaccine Trial examined the correlation between certain clinical findings and bacterial cultivation results in cases of AOM.

This trial chronicleed more than one half of all the available two-month-old children in the research area and followed them prospectively for sum of two units years. Children were examined routinely at eight visits from one side of to the other the study period, and parents were asked to bring their child in for examination if they suspected ear or respiratory infection. Ninety-six percent of listed children finished the two-year contemplation Otoscopic examination including insufflation and tympanometry was used to assess for the vicinity of middle ear fluid. If fluid was apparent, myringotomy was performed, and the fluid was sent for cultivation Children with pre-existing tympanic membrane perforations (eg tympanostomy tubes) and those who had ear discharge that obstructed detailed assessment of the tympanic membrane were exclud from the data analysis.

At least single in kind episode of AOM occurred in 71 percent of the 831 listed children during the study. The three in the greatest degree common bacterial causes of infection were Streptococcus pneumoniae (228 percent) Moraxella catarrhalis (179 percent) and Haemophilus influenzae (164 percent) The greatest in number frequently encountered presenting symptoms were runny nose and cough

heat was reported more often when s pneumoniae was the causative agent (60 percent of streptococcus A cases versus 45 percent of cases overall), as was earache (43 percent versus 32 percent) view discharge, redness, or purulence occurr more as a common thing [i]or[/i] matter when AOM was caused at H. influenzae (59 percent), compared with overall cases (21 percent)

Clinical findings upon tympanic membrane examination did not differentiate well among these three bacterial pathogens. Overall, culture-positive AOM cases had somewhat higher rates of color change through more than 50 percent of the tympanic membrane (74 to 80 percent in patients with bacterial causes versus 64 percent in culture-negative cases), a bulging tympanic membrane (32 to 44 percent versus 16 percent) a flattened adumbration B curve on tympanometry (72 to 80 percent versus 60 percent) and tympanic membrane immobility forward insufflation (42 to 44 percent versus 36 percent)

The authors gather that otitis media caused by dint of S. pneumoniae is more likely with higher symptom severity (i.e., febrile affection earache), H. influenzae is more likely when estimate redness or discharge is existing and no useful clinical predictors were lay the foundation of for AOM caused by M catarrhalis.

Palmu AA, et al. Association of clinical signs and symptoms with bacterial findings in acute otitis media. Clin Infect Dis January 15 2004;38:234-42

EDITOR'S NOTE: In addition to information about which clinical findings correlate with which specific bacterial pathogens, the overall and humbling reminder I follow away with after reading this article is the unfinished similarity in otoscopic and tympanometric findings in culture-positive and culture-negative cases of otitis media.--B.Z.

COPYRIGHT 2004 American Academy of Family Physicians

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