A child with recurrent acute otitis media

Acute otitis media refers to inflammation of the middle ear of rapid onset presenting with local symptoms, the most common being earache and rubbing or tugging of the affected ear and systemic signs such as fever, irritability and poor sleep. Acute otitis media may be caused by viral or bacterial pathogens. The commonest viral pathogens are Respiratory Syncytial Virus, Adenovirus and Influenza A Virus. Three bacterial pathogens predominate as the cause of acute otitis media – Streptococcus pneumoniae, Haemophilus influenzae type B and Moraxella catarrhalis. Acute otitis media is one of the most common infectious diseases in childhood. By the age of 2 years, 70% of all children have suffered at least one episode of acute otitis media. Approximately 5–15% of children experience four or more episodes per year. Recurrent acute otitis media, defined as more than four episodes in 6 months, merits referral to an Otolaryngologist. This condition has a considerable negative impact on the quality of life of children and causes great concern to their caregivers. • Has the child had those symptoms most commonly associated with acute otitis media? i.e. earache, fever, irritability, otorrhoea, lethargy, anorexia and vomiting. It is important to bear in mind that these lack sensitivity and specificity for diagnosis particularly in children under 2 years of age. Earache is the single most important symptom. • Has there been a preceding history of upper respiratory symptoms including cough and rhinorrhoea? Prior to the onset of symptoms of acute otitis media, the child frequently has symptoms of an upper respiratory tract infection. This may add weight to the diagnosis when the child is seen in the resolution phase especially if the symptoms are non-specific in a very young child. • What was the age of the child at the time of the first episode? In the first 6 months after birth passive protection against disease is provided by placental transport of antibodies of the IgG1 subtype. A young age at the time of the first episode may relate to an immature or defective immunologic status which becomes apparent after 6 months. • How many episodes has the child suffered in the previous 6 months? • Are the parents concerned about the child’s hearing? • What environmental risk factors exist? These include passive smoking, bottle feeding, low socio-economic group and exposure to large numbers of other children. A meta-analysis of otitis media risk factor studies confirmed that child care outside the home and parental smoking were the factors that most significantly increased the occurrence of acute otitis media and that breastfeeding for 3 or 6 months conferred a protective benefit. • Associated nasal symptoms such as obstruction, rhinorrhoea and snoring may affect decisions regarding surgery