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The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study

Gibney, Katherine B., Morris, Peter S., Carapetis, Jonathan R., Skull, Susan A., Smith-Vaughan, Heidi C., Stubbs, Elizabeth and Leach, Amanda J. (2005). The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study. BMC Pediatrics,5(1):16-23.

Document type: Journal Article
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Title The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study
Author Gibney, Katherine B.
Morris, Peter S.
Carapetis, Jonathan R.
Skull, Susan A.
Smith-Vaughan, Heidi C.
Stubbs, Elizabeth
Leach, Amanda J.
Journal Name BMC Pediatrics
Publication Date 2005
Volume Number 5
Issue Number 1
ISSN 1471-2431   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-26444473255
Start Page 16
End Page 23
Total Pages 8
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
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.

Conclusion: 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.
Keywords acute otitis media (AOM)
Australian Aboriginal children
bacterial nasopharyngeal colonisation
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