title: Symptoms or symptom-based scores cannot predict acute otitis media at otitis-prone age.
abstract: OBJECTIVE
  Acute symptoms are used to diagnose and manage acute otitis media (AOM). We studied whether AOM could be predicted by the reason for parental suspicion of AOM or by the occurrence, duration, and/or severity of symptoms. We also compared scores including or excluding tympanic-membrane examination of children with and without AOM.
  
  
  METHODS
  Children aged 6 to 35 months with parental suspicion of AOM were eligible. Before tympanic-membrane examination, we registered on a structured questionnaire the reason for parental suspicion of AOM, symptoms, and score components.
  
  
  RESULTS
  Of 469 children studied, 237 had AOM and 232 had respiratory tract infection without AOM. The most common reason for parental suspicion of AOM, restless sleep, was not predictive for AOM (RR: 1.0 [95% CI: 0.8-1.2]), nor was ear-rubbing (relative risk [RR]: 0.7 [95% confidence interval (CI): 0.5-1.0]). Neither the occurrence of fever (RR: 1.2 [95% CI: 1.0-1.4]) nor the highest mean temperature within 24 hours predicted AOM, nor did the occurrences of ear-related, nonspecific, respiratory, or gastrointestinal symptoms. The duration and severity of symptoms were not predictive for AOM, although rhinitis lasted longer and conjunctivitis was more severe in children with AOM. The clinical/otologic score (median: 4.0 vs 2.0; P = .000) and the AOM total-severity index (11.0 vs 6.0; P = .000), both including symptoms and tympanic-membrane examination, were higher in those with AOM. The AOM severity-of-symptom scale, based solely on symptoms, was equal in children with and without AOM (6.0 vs 6.0; P = .917).
  
  
  CONCLUSIONS
  AOM cannot be predicted by the occurrence, duration, or severity of symptoms at otitis-prone age. Likewise, solely symptom-based scores do not differentiate between respiratory tract infections with or without AOM. Thus, tympanic-membrane examination is crucial in the diagnosis and severity classification of AOM in clinical practice and research settings.
authors.affiliation: Department of Pediatrics, Turku University Hospital, Turku, Finland.
authors.forename: Miia K
authors.initials: MK
authors.lastname: Laine
authors.forename: Paula A
authors.initials: PA
authors.lastname: Tähtinen
authors.forename: Olli
authors.initials: O
authors.lastname: Ruuskanen
authors.forename: Pentti
authors.initials: P
authors.lastname: Huovinen
authors.forename: Aino
authors.initials: A
authors.lastname: Ruohola
mesh_terms: D000158:Acoustic Impedance Tests; D000208:Acute Disease; D002675:Child, Preschool; D015897:Comorbidity; D003231:Conjunctivitis / Q000175:diagnosis; D005260:Female; D005387:Finland; D005759:Gastroenteritis / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis*; D038781:Otoscopy; D011320:Primary Health Care; D057216:Propensity Score; D012141:Respiratory Tract Infections / Q000175:diagnosis; D012220:Rhinitis / Q000175:diagnosis; D011795:Surveys and Questionnaires; D014432:Tympanic Membrane / Q000473:pathology