title: The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study.
abstract: BACKGROUND
  It is unclear why some children with acute otitis media (AOM) have poor outcomes. Our aim was to describe the clinical course of AOM and the associated bacterial nasopharyngeal colonisation in a high-risk population of Australian Aboriginal children.
  
  
  METHODS
  We examined Aboriginal children younger than eight years who had a clinical diagnosis of AOM. Pneumatic otoscopy and video-otoscopy of the tympanic membrane (TM) and tympanometry was done every weekday if possible. We followed children for either two weeks (AOM without perforation), or three weeks (AOM with perforation), or for longer periods if the infection persisted. Nasopharyngeal swabs were taken at study entry and then weekly.
  
  
  RESULTS
  We enrolled 31 children and conducted a total of 219 assessments. Most children had bulging of the TM or recent middle ear discharge at diagnosis. Persistent signs of suppurative OM (without ear pain) were present in most children 7 days (23/30, 77%), and 14 days (20/26, 77%) later. Episodes of AOM did not usually have a sudden onset or short duration. Six of the 14 children with fresh discharge in their ear canal had an intact or functionally intact TM. Perforation size generally remained very small (<2% of the TM). Healing followed by re-perforation was common. Ninety-three nasophyngeal swabs were taken. Most swabs cultured Streptococcus pneumoniae (82%), Haemophilus influenzae (71%), and Moraxella catarrhalis (95%); 63% of swabs cultured all three pathogens.
  
  
  CONCLUSIONS
  In this high-risk population, AOM was generally painless and persistent. These infections were associated with persistent bacterial colonisation of the nasopharynx and any benefits of antibiotics were modest at best. Systematic follow up with careful examination and review of treatment are required and clinical resolution cannot be assumed.
authors.affiliation: Department of Medicine, Royal Darwin Hospital, Australia. katherinegibney@hotmail.com
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Gibney
authors.forename: Peter S
authors.initials: PS
authors.lastname: Morris
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
authors.forename: Susan A
authors.initials: SA
authors.lastname: Skull
authors.forename: Heidi C
authors.initials: HC
authors.lastname: Smith-Vaughan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stubbs
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Leach
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D001936:Moraxella catarrhalis / Q000302:isolation & purification; D009305:Nasopharynx / Q000382:microbiology*; D010033:Otitis Media / Q000188:drug therapy / Q000208:ethnology / Q000503:physiopathology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation
chemical_list: D000900:Anti-Bacterial Agents