Morris PS, Yonovitz A, Leach AJ, Mathews JD; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1997; 13: 105.
The Menzies School of Health Research, Darwin, Australia.
BACKGROUND: Australian Aboriginal children have the highest rates chronic suppurative otitis media (CSOM) reported in the literature. In some communities more than 50% of young children have perforations of the ear drum and significant hearing loss. Surprisingly, rates of acute otitis media (AOM) have not been described. This has lead to some confusion regarding the relationship between the 2 diseases. OBJECTIVE: To document the rates of AOM in infants in a rural Aboriginal commuity as part of placebo controlled clinical trial of antibiotics to prevent chronic middle ear disease. METHODS: The middle ear state of each infant was assessed using pneumatic otoscopy, video pneumatic otoscopy and typanometry. The diagnosis of AOM was made using otoscopic criteria recommended by Paradise [Paradise, JL. On classifying otitis media as suppurative or nonsuppurative, with a suggested clinical schema. J Pediatr 1987;111:948-51]. The intact ear drum had to demonstrate either marked bulging, marked redness, or the combination of marked bulging and marked redness for the diagnosis to be made. Where there was some doubt about the diagnosis, the video image could be reviewed. RESULTS: A total of 284 examinations have occurred in 44 infants over a 10 month period. Most have been seen on multiple occasions (mean 6.5, range 1-11). Despite the fact that 36 infants have been enrolled in the study and may be receiving regular antibiotic therapy, the incidence of AOM was still extremely high. The diagnosis of AOM was made 69 times in 31 infants. Marked bulging of the drum was the most important clinical sign. In babies followed from birth, the first episode of AOM usually occurred in the 1st few months of life when examination is most difficult. Most cases were relatively asymptomatic and mothers did not regard their babies as being unwell. CONCLUSIONS: These results have major implications for the prevention of chronic ear disease in high risk populations. The clinical presentation of AOM is quite different to that described in most medical textbooks. The early age of onset, the lack of symptoms and the difficulty of examination could expain why this diagnosis is not often made by health care workers caring for these children. Other common diseases may also need to be re-evaluated when considering the application of health technology in developing countries.
Publication Types:
Keywords:
- Acute Disease
- Anti-Bacterial Agents
- Child
- Chronic Disease
- Developing Countries
- Ear, Middle
- Humans
- Incidence
- Infant
- Otitis Media
- Otitis Media with Effusion
- Otitis Media, Suppurative
- Rural Population
- Tympanic Membrane
- diagnosis
- hsrmtgs
Other ID:
UI: 102233174
From Meeting Abstracts