Kontiokari T, Koivunen P, Niemelä M, Pokka T, Uhari M
Department of Pediatrics, University of Oulu, Finland.
Pediatr Infect Dis J. 1998 Aug;17(8):676-9. doi: 10.1097/00006454-199808000-00003.
The decision to seek medical advise for children during upper respiratory infections is largely based on the parental assumption that the child's symptoms are related to acute otitis media. The symptoms related to acute otitis media, however, are considered nonspecific.
Altogether 857 healthy day-care children (mean age, 3.7 years) were followed up for 3 months, and the symptoms of each child were compared during upper respiratory infections with and without acute otitis media.
A total of 138 children had upper respiratory infections with and without acute otitis media. The symptom with the strongest association with acute otitis media was earache [relative risk (RR), 21.3; 95% confidence intervals (CI), 7.0 to 106, P < 0.0001] but sore throat (RR = 3.2; CI = 1.1 to 11; P = 0.027), night restlessness (RR = 2.6; CI = 1.1 to 6.9; P = 0.024) and fever (RR = 1.8; CI = 1.1 to 3.2; P = 0.025) also had significant associations. Logistic regression analysis showed 71% of the cases to be correctly diagnosed on the basis of the symptoms of earache and night restlessness. The parents were able to predict the presence of acute otitis media with a sensitivity and specificity of 71 and 80%, respectively (positive predictive value, 51%; negative predictive value, 90%).
Despite the limited value of symptoms in differentiating acute otitis media from upper respiratory infection, the parents are able to predict acute otitis media somewhat reliably. More symptoms than have been reported earlier appeared to be associated with acute otitis media.
对于上呼吸道感染的儿童，家长决定寻求医疗建议很大程度上基于这样一种假设，即孩子的症状与急性中耳炎有关。然而，与急性中耳炎相关的症状被认为是非特异性的。
总共857名健康日托儿童（平均年龄3.7岁）接受了3个月的随访，并比较了每个儿童在上呼吸道感染伴有和不伴有急性中耳炎时的症状。
共有138名儿童出现了伴有和不伴有急性中耳炎的上呼吸道感染。与急性中耳炎关联最强的症状是耳痛[相对危险度（RR），21.3；95%可信区间（CI），7.0至106，P<0.0001]，但喉咙痛（RR = 3.2；CI = 1.1至11；P = 0.0
