Ear Infections Develop in 1 Out of 5 Kids with Respiratory Viruses

More than 20 percent of young children with colds or other respiratory viral infections will develop middle ear infections of varying severityincluding some mild infections that don't require antibiotics, according to a study in the February issue of the Pediatric Infectious Disease Journal.

The study shows the "full spectrum" of acute otitis media (AOM) in infants and toddlers with respiratory virusessometimes including mild infection in one ear but severe infection in the other. The lead author was Dr. Stella U. Kalu of University of Texas Medical Branch at Galveston.

The researchers analyzed cases of AOM developing after upper respiratory viral infectionssuch as a cold or "flu"in 294 children, aged six months to three years. The study was unique because the children were enrolled before they got sickmost studies are limited to children who have already been diagnosed with AOM. This prospective research design provides a unique illustration of the natural history of AOM in the setting of viral upper respiratory infections.

Overall, 22 percent of the children developed AOM during the first week of a respiratory infection. The diagnosis of AOM was based on the presence of symptoms (such as fever and earache) plus inflammation of the eardrum and fluid in the middle ear (seen by the doctor using an otoscope). Another seven percent of children had inflammation of the eardrum without fluid in the middle ear.

The eardrum inflammation was rated mild in eight percent of children with AOM, moderate in 59 percent, and severe in 35 percent. One hundred twenty-six children had AOM in both earsin 54 percent of these cases, the severity of inflammation was different between ears.

The children were generally treated without antibiotics, if possible. Of 28 children with mild AOM, 24 got better without antibiotics. Four got worse, and three eventually required antibiotics.

Acute otitis media is one of the most common childhood diseases and a major reason for antibiotic prescriptions. Most cases of AOM are preceded by a cold or other respiratory viral infection. Doctors may see AOM at different stages of the disease; their treatment recommendations may vary according to the signs and symptoms they see at that time.

The new study provides uniquely detailed information, including the otoscopy findings, on AOM occurring in young children with respiratory viral infections. The results suggest that about 22 percent of children with a cold or other respiratory infections will develop AOM. These ear infections can range from mild to severe, and may differ from one ear to the other.

"Management of AOM likely depends on stages of the infection," Kalu and colleagues write. Their experience suggests that many children with mild AOM can be managed without antibiotics. They believe their results may be useful in developing some type of clinical score to help in differentiating children who require antibiotics from those who do not. The researchers conclude, "A clinical scoring system that can help identify children who will benefit from treatment will lead to reduction in antibiotic use of AOM."