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.
van Balen
F A
FA
Department of Family Practice, University of Utrecht, The Netherlands. F.A.M.VanBalen@med.uu.nl
de Melker
R A
RA
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