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Clinical Spectrum of Acute Otitis Media Complicating Upper Respiratory Tract Viral Infection

Kalu, Stella U. MD*; Ataya, Ramona S. MD*; McCormick, David P. MD*; Patel, Janak A. MD*; Revai, Krystal MD, MPH*; Chonmaitree, Tasnee MD*†

The Pediatric Infectious Disease Journal: February 2011 - Volume 30 - Issue 2 - p 95-99
doi: 10.1097/INF.0b013e3181f253d5
Original Studies

Background: Acute otitis media (AOM) often occurs as a complication of upper respiratory tract infection (URI).

Objective: To describe otoscopic findings during URI, the full clinical spectrum of AOM, and outcome of cases managed with watchful waiting.

Methods: In a prospective study of 294 healthy children (6 months–3 years), characteristics of AOM complicating URI were studied. Otoscopic findings were categorized by tympanic membrane (TM) position, color, translucency, and mobility. Otoscopic score was assigned based on McCormick otoscopy scale (OS)-8 scale.

Results: During days 1 to 7 of URI, otoscopic findings at 1114 visits were consistent with AOM in 22%; myringitis (inflamed TM, no fluid) was diagnosed in 7%. In AOM episodes diagnosed within 28 days of URI onset, TM position was described as: nonbulging (19%), mild bulging (45%), bulging (29%), and TM perforation occurred in (6%). OS-8 scale showed mild TM inflammation (OS, 2–3) in 6%, moderate (OS, 4–5) in 59%, and severe (OS, 6–8) in 35%. In 54% of 126 bilateral AOM episodes, inflammation of both TMs was at different stages. Of 28 cases of nonsevere AOM managed with watchful waiting, 4 progressed and 3 later required an antibiotic.

Conclusions: AOM is a spectrum of infection that may present at various stages, even in the same child with bilateral disease. During URI, otoscopic changes are observed from the first day of onset. Understanding the wide clinical spectrum of AOM is needed to help with future clinical trial design and development of a scoring system to establish treatment criteria that will minimize antibiotic use.


From the Departments of *Pediatrics and †Pathology, University of Texas Medical Branch at Galveston, Galveston, TX.

Accepted for publication July 14, 2010.

Supported by National Institutes of Health grants R01 DC005841. The study was conducted at the General Clinical Research Center at the University of Texas Medical Branch, supported by the National Center for Research Resources (National Institutes of Health, US Public Health Service) grant M01 RR 00073.

Krystal Revai is currently at Department of Pediatrics, University of Illinois College of Medicine, Chicago, IL.

Address for correspondence: Tasnee Chonmaitree, MD, Division of Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555–0371. E-mail:

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© 2011 Lippincott Williams & Wilkins, Inc.