title: Factors associated with poor outcome in children with acute otitis media.
abstract: OBJECTIVE
  To identify factors determining poor outcome in children with acute otitis media (AOM).
  
  
  METHODS
  We considered the following factors in children with AOM: age; gender; the presence of group nursing; the presence of siblings; the duration of breastfeeding; and the type of bacteria isolated from the middle ear fluid (MEF) or nasopharynx. The 73 pediatric patients studied included 61 examined in outpatient clinics and 12 seen at a children's home.
  
  
  RESULTS
  Of the 61 children examined in outpatient clinics, 32 (52%) had persistent MEF (fluid accumulation in the middle ear persisting for up to 1 month after treatment); 14 (23%) had early recurrence of AOM (within 1 month following an initial improvement); and 14 (23%) developed recurrent AOM (> 3 recurrences during 6 months of follow-up). Using univariate and multivariate analyses, age < 2 years was found to be significantly related to the development of recurrent AOM and an absence of group nursing was found to be significantly related to the development of early recurrence. Persistent MEF was significantly related to the development of recurrent AOM. There was no difference between bacterial species isolated from the MEF or nasopharynx in terms of clinical outcome.
  
  
  CONCLUSIONS
  These findings indicate that particularly close long-term follow-up is necessary for children aged < 2 years and children with a middle ear effusion that persists for up to 1 month after treatment.
authors.affiliation: Department of Otolaryngology, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Monobe
authors.forename: Toshio
authors.initials: T
authors.lastname: Ishibashi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujishiro
authors.forename: Masanobu
authors.initials: M
authors.lastname: Shinogami
authors.forename: Jun
authors.initials: J
authors.lastname: Yano
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology; D010033:Otitis Media / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome