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Symptoms do not predict AOM in children

Clinical Question:
Do specific signs or symptoms reported by parents increase the likelihood of acute otitis media in children?

Bottom Line:
In a high-likelihood group of children (50%), no sign, symptom, or cluster of signs and symptoms predicted acute otitis media (AOM) better than flipping a coin. Similarly, parents are correct approximately half the time. This information can be used to gently counsel parents that a sleepless night or ear tugging does not indicate AOM and, given the paucity of evidence of benefit of treatment, that an office visit is necessary for a confirmed diagnosis. (LOE = 3b)

Laine MK, Tahtinen PA, Ruuskanen O, Huovinen P, Ruohola A. Symptoms or symptom-based scores cannot predict acute otitis media at otitis-prone age. Pediatrics 2010;125:e1154-e1161.  [PMID:20368317]

Study Design:
Diagnostic test evaluation


Outpatient (primary care)

The Finnish authors of this study enrolled 469 children aged 6 months to 35 months whose parents suspected AOM and called for an appointment; half of the children were eventually diagnosed with AOM. Restless sleep (of the child and, presumably, also of the parent) accounted for a parental suspicion of AOM in 29% of cases; ear pain or rubbing and irritability were other frequent triggers. Before examination, parents were queried regarding the occurrence, duration, and severity of 17 signs. Following this questioning, the child was examined, and a diagnosis of AOM was made when middle ear fluid was detected by pneumatic otoscopy, at least 1 acute inflammatory sign of the tympanic membrane was seen, and symptoms and signs of acute infection were present. The physician performing the examination was the same investigator that collected the information; this prior knowledge of symptoms could have colored their interpretation of the examination findings. No parental suspicion, sign, symptom, or cluster of signs and symptoms predicted AOM or differentiated it from a respiratory infection.


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