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Is Bilateral Acute Otitis Media Clinically Different Than Unilateral Acute Otitis Media?

Leibovitz, Eugene MD*; Asher, Elad MD*; Piglansky, Lolita MD*; Givon-Lavi, Noga*; Satran, Robert MD*; Raiz, Simon MD†; Slovik, Yuval MD†; Leiberman, Alberto MD†; Dagan, Ron MD*

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318060cc19
Original Studies

Background: Information regarding the specific characteristics of bilateral acute otitis media (BAOM) versus unilateral acute otitis media (UAOM) is lacking.

Objectives: To compare the epidemiologic, microbiologic, and clinical characteristics of BAOM with UAOM in children.

Patients and Methods: 1026 children aged 3–36 months (61%, <1 year of age) with AOM were enrolled during 1995–2003. All patients had tympanocentesis and middle ear fluid (MEF) culture at enrollment. Clinical status was determined by a clinical/otologic score evaluating severity (0 = absent to 3 = severe, maximal score 12) of patient's fever and irritability and tympanic membrane redness and bulging. Multivariate logistic regression models were used to estimate the risk of BAOM and UAOM presenting with a high severity score (≥8).

Results: Six-hundred twenty-three (61%) patients had BAOM. Positive MEF cultures were recorded in 786 (77%) patients. More patients with BAOM had positive MEF cultures than patients with UAOM (517 of 623, 83% versus 269 of 403, 67%; P < 0.01). Nontypable Haemophilus influenzae was more common in BAOM than in UAOM (390 of 623, 63% versus 170 of 430, 42%; P < 0.01). Overall, the clinical/otologic score showed higher severity in culture-positive than in culture-negative patients (8.2 ± 2.0 versus 7.7 ± 2.2; P < 0.001) and in BAOM than in UAOM (8.3 ± 2.1 versus 7.8 ± 2.1; P = 0.001). Clinical/otologic score of ≥8 was more frequent in BAOM than in UAOM patients (371, 61.8% versus 200, 51.3%; P = 0.001). The estimated risk for BAOM patients (compared with UAOM patients) to present with a score ≥8 was 1.5. The association between BAOM and clinical/otologic score ≥ 8 was maintained after adjustment for age, previous AOM history, and culture results at enrollment.

Conclusions: (1) BAOM is frequent; (2) Nontypable H. influenzae is more frequently involved in the etiology of BAOM than of UAOM; (3) The clinical picture of BAOM is frequently more severe than that of UAOM, but overlap of clinical symptoms is common.

Author Information

From the *Pediatric Infectious Disease Unit and †Department of Otolaryngology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Accepted for publication March 21, 2007.

Address for correspondence: Eugene Leibovitz, MD, Pediatric Infectious Disease Unit, Soroka University Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.