Multiple factors linked to recurrent infant AOM, treatment failure
By Kirsty Oswald, medwireNews Reporter
26 August 2013
Int J Pediatr Otorhinolaryngol 2013; Advance online publication

medwireNews: Researchers from Egypt have identified several clinical factors that significantly increase the risk for recurrent acute otitis media (AOM) in infants.

Their retrospective study involved 340 infants aged 3 to 24 months who had three or more episodes of AOM in a 6-month period. All the infants received a 10-day course of antibiotics at each recurrence, and surgical management in the form of adenoidectomy and/or myringotomy was performed in those with persistent disease.

Overall, 221 (65%) infants showed early recurrence of signs and symptoms within 1 month of initial improvement, and 91 (26.8%) showed treatment failure requiring surgical intervention.

The team, led by Mosaad Abdel-Aziz (Cairo University), found that recurrent AOM was significantly associated with age, with those aged over 6 months having more recurrences than did younger infants (mean, 5.6 vs 4.6). Recurrence was also more common in those presenting with upper respiratory tract infection (5.8 vs 5.1 in those without infection), those who had been breastfed for less than 3 months (5.7 vs 5.1 in those breastfed for longer), and those using pacifiers (5.8 vs 5.1 in non-users). Additionally, infants with obstructive adenoid had a particularly high recurrence rate at 6.5 compared with 5.0 in those without the complication.

However, the researchers found no association between recurrent AOM and gender, prematurity, exposure to parental smoking, family size, allergy, or craniofacial abnormality, which have all been suggested as risk factors in previous studies; nor did they find any factor significantly associated with early recurrence.

Treatment failure was particularly prevalent among infants with obstructive adenoid, occurring in 88.0%. This translated to a 4.6-fold greater odds for failure compared with those without hypertrophy, in whom the rate was 20.9%.

Additionally, breastfeeding for less than 3 months was associated with a 2.3-fold greater odds for treatment failure compared with breastfeeding for longer (36.3 vs 23.8%).

The authors conclude that studies such as theirs “provide helpful prognostic indicators in order to achieve better preventive measures that can reduce AOM among infants.”

“It is worth mentioning that our study was based mainly on investigating the relation between [recurrent] AOM and their risk factors from the clinical point of view, however a bacteriologic and immunological correlates should be considered in further studies,” they add, writing in the International Journal of Pediatric Otorhinolaryngology.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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