Persistent otitis media with effusion: can it be predicted? A family practice follow-up study in children aged 6 months to 6 years.
BACKGROUND
Otitis media with effusion (OME) has a high rate of spontaneous resolution, and a policy of waiting and watching for 3 months is justified. The decision about further treatment should be individualized, depending on duration and symptoms. Knowledge of the determinants for persistent OME would be helpful for identifying patients with a need for active treatment or increased monitoring for complications.


METHODS
A total of 433 children aged 6 months to 6 years were monitored for 3 months in the offices of 57 family physicians. A questionnaire pertaining to determinants was completed. The outcome measures were: presence of unilateral or bilateral OME or bilateral OME after 3 months. The outcome was determined on the basis of tympanometry results. We performed bivariate and multivariate analyses.


RESULTS
The presence of an upper respiratory tract infection (URTI) at the follow-up visit was associated with finding OME at that visit. When a URTI was present, no other determinants for persistent OME were found. When absent, the determinants for persistent bilateral OME were: no history of adenoidectomy, an episode of acute otitis media (AOM) in the first year of life, and month of entry into the study (June-November). For persistent unilateral or bilateral OME, the only significant determinant was an episode of AOM in the first year of life.


CONCLUSIONS
Childrenwith 1 or more of the following factors need special attention for prevention of the sequelae of persistent OME: no history of adenoidectomy, AOM in the first year of life, and the presence of bilateral OME in the period between June and November.
Department of Family Practice, University of Utrecht, The Netherlands. F.A.M.VanBalen@med.uu.nl
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van Balen
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de Melker
D000208:Acute Disease; D000233:Adenoidectomy; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000150:complications*; D010034:Otitis Media with Effusion / Q000209:etiology* / Q000517:prevention & control; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000150:complications; D012307:Risk Factors; D012621:Seasons