Department of Pediatrics, Turku University Hospital, Turku, Finland.
Pediatrics. 2010 May;125(5):e1154-61. doi: 10.1542/peds.2009-2689. Epub 2010 Apr 5.
Acute symptoms are used to diagnose and manage acute otitis media (AOM). We studied whether AOM could be predicted by the reason for parental suspicion of AOM or by the occurrence, duration, and/or severity of symptoms. We also compared scores including or excluding tympanic-membrane examination of children with and without AOM.
Children aged 6 to 35 months with parental suspicion of AOM were eligible. Before tympanic-membrane examination, we registered on a structured questionnaire the reason for parental suspicion of AOM, symptoms, and score components.
Of 469 children studied, 237 had AOM and 232 had respiratory tract infection without AOM. The most common reason for parental suspicion of AOM, restless sleep, was not predictive for AOM (RR: 1.0 [95% CI: 0.8-1.2]), nor was ear-rubbing (relative risk [RR]: 0.7 [95% confidence interval (CI): 0.5-1.0]). Neither the occurrence of fever (RR: 1.2 [95% CI: 1.0-1.4]) nor the highest mean temperature within 24 hours predicted AOM, nor did the occurrences of ear-related, nonspecific, respiratory, or gastrointestinal symptoms. The duration and severity of symptoms were not predictive for AOM, although rhinitis lasted longer and conjunctivitis was more severe in children with AOM. The clinical/otologic score (median: 4.0 vs 2.0; P = .000) and the AOM total-severity index (11.0 vs 6.0; P = .000), both including symptoms and tympanic-membrane examination, were higher in those with AOM. The AOM severity-of-symptom scale, based solely on symptoms, was equal in children with and without AOM (6.0 vs 6.0; P = .917).
AOM cannot be predicted by the occurrence, duration, or severity of symptoms at otitis-prone age. Likewise, solely symptom-based scores do not differentiate between respiratory tract infections with or without AOM. Thus, tympanic-membrane examination is crucial in the diagnosis and severity classification of AOM in clinical practice and research settings.
急性症状用于诊断和管理急性中耳炎（AOM）。我们研究了父母怀疑 AOM 的原因或症状的发生、持续时间和/或严重程度是否可以预测 AOM。我们还比较了包括或不包括鼓膜检查的患有和不患有 AOM 的儿童的评分。
年龄在 6 至 35 个月、父母怀疑患有 AOM 的儿童符合入选标准。在进行鼓膜检查之前，我们在结构化问卷上记录了父母怀疑 AOM 的原因、症状和评分组成部分。
在 469 名研究的儿童中，237 名患有 AOM，232 名患有无 AOM 的呼吸道感染。父母怀疑 AOM 的最常见原因——睡眠不安，对 AOM 没有预测作用（RR：1.0[95%置信区间：0.8-1.2]），耳挠也没有（相对风险[RR]：0.7[95%置信区间：0.5-1.0]）。发烧的发生（RR：1.2[95%置信区间：1.0-1.4]）或 24 小时内的最高平均体温均不能预测 AOM，耳部相关的、非特异性的、呼吸道或胃肠道症状的发生也不能预测 AOM。症状的持续时间和严重程度对 AOM 没有预测作用，尽管患有 AOM 的儿童的鼻炎持续时间更长，结膜炎更严重。临床/耳科学评分（中位数：4.0 与 2.0；P =.000）和 AOM 总严重度指数（11.0 与 6.0；P =.000），均包括症状和鼓膜检查，在患有 AOM 的儿童中更高。仅基于症状的 AOM 症状严重程度量表在患有和不患有 AOM 的儿童中相等（6.0 与 6.0；P =.917）。
在易患 AOM 的年龄，AOM 不能通过症状的发生、持续时间或严重程度来预测。同样，仅基于症状的评分并不能区分患有或不患有 AOM 的呼吸道感染。因此，在临床实践和研究环境中，鼓膜检查对于 AOM 的诊断和严重程度分类至关重要。
