Otitis media: the middle ear effusion total white cell count.

The middle ear effusion (MEE) total white cell count (TWCC) was correlated with clinical and bacteriologic data in 184 MEEs from 125 patients diagnosed as having acute primary and recurrent otitis media and chronic otitis media with effusion. The MEE total white cell count was classified as high, low, or acellular. Polymorphonuclear leukocytes predominate in the MEE having a high TWCC. The overall incidence of culture-positive MEE was 62.5 percent. A cellular component was found in 81 percent of the MEEs, 63 percent having a neutrophilic-predominant high TWCC. In very young children (up to 2 years old) a neutrophilic-predominant high TWCC was found in 80 percent of MEEs as compared with 28 percent in patients over 5 years old. According to the MEE type, neutrophilic-predominant high TWCCs were found in 89 percent of the purulent effusions, 46 percent of the mucoid, and 35 percent of the serous effusions. The incidence of neutrophilic-predominant high TWCC was 78 percent in acute primary 76 percent in recurrent otitis media and 18 percent in chronic otitis media with effusion. The impact of age on the MEE cellularity was shown to be independent of the chronicity of the disease. The incidence of neutrophilic-predominant high TWCC in MEE in which Streptococcus Pneumoniae or Hemophilus influenzae was identified was 85 percent and 92 percent respectively. The diagnostic value of a high TWCC in predicting a culture-positive MEE was shown by a sensitivity of 83 percent, false positivity of 25 percent, and false negativity of 27.5 percent.