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21-07-2013 | Infectious disease | Article

Outpatient clinics should be alert to acute otitis media


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medwireNews: Japanese researchers say that physicians should check the tympanic membrane for signs of acute otitis media in all pediatric outpatients, regardless of symptoms or patient history.

Their study, which included 8283 outpatient clinic visits in Sado Island, Japan, over a 2-year period, showed that up to 5% of pediatric patients had acute otitis media, including those with no symptoms.

Taketo Otsuka (Sado General Hospital, Niigata) and colleagues, who say that the incidence of the condition in Japan has to date been unknown, found that patients at 354 clinic visits in their sample had acute otitis media (4.3%). This rate was highest among young patients and decreased with age such that it was 5.5% among those aged 0 to 5 years, and 1.8% among those aged 6 to 18 years.

Children aged 1 year had a particularly high incidence at 0.54 annual episodes per child, in contrast to a rate of just 0.01 among children aged 7 years and older.

Notably, of all the children diagnosed with acute otitis media, around half (51.9%) had never had the condition before. Recurrent episodes were reported in 46.8% of children.

Almost all (83.9%) patients had more than one pathogen present. Streptococcus pneumoniae was the most commonly detected pathogen, present in 50.5% of nasopharyngeal swab samples, while Haemophilus influenzae and Moraxella catarrhalis were present in 45.9% and 44.9%, respectively.

Furthermore, the authors note that bacterial strains were frequently treatment-resistant, highlighting that these types of infection “are still a major concern in Japan.”

Writing in PLoS One, they explain: “A history of acute onset of signs and symptoms is controversial for diagnosis of [acute otitis media],” adding that it has been suggested that tympanic membrane bulging alone is sufficient for a diagnosis of the condition.

Therefore, they conclude: “Pediatricians as well as otolaryngologists should check the tympanic membrane findings of all pediatric outpatients.”

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

By Kirsty Oswald, medwireNews Reporter