University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• In otherwise healthy children, is acute otitis media follow-up, as compared with no follow-up, truly necessary?

Clinical Bottom Lines

1. There is no consensus in the pediatric community regarding timing of post-treatment follow-up of acute otitis media or who should be receiving follow-up.
2. The study summarized suggests that parents can be reliable predictors of persistent acute otitis media or resolved acute otitis media after a child is treated appropriately with antibiotics.¹
3. There is not much literature available related to this topic. The findings discussed below are based on a small prospective, non-randomized, cohort study.

Summary of Key Evidence

1. 304 children ages 6 months to 4 years were enrolled in this prospective, non-randomized, cohort study.¹
2. The study was conducted with patients who were members of the Braintree Center of the Harvard Community Health Plan (a prepaid HMO).
3. Patients chosen to participate in the study had both a clinical diagnosis of acute otitis media and a middle ear effusion confirmed with tympanometry or acoustic reflectometry.
4. Parents filled out a questionnaire at diagnosis & at a follow-up visit 2-3 weeks later.
5. Study observations were based on only 181 of the original 304 patients (123 patients were lost to follow-up).
6. 24.9% of patients (45/181) had persistent acute otitis media at a follow-up visit 2-3 weeks later.
7. Parents predictions at post-treatment follow-up (regarding persistent acute otitis media or resolved acute otitis media) were accurate 79.5% of the time.
8. The positive predictive value of the study was found to be 59.1% (when parents thought that their child had persistent acute otitis media they were correct 59.1% of the time).
9. The negative predictive value was found to be 86.3% (when parents thought that their child's acute otitis media had resolved the were correct 86.3% of the time).
10. This study suggested that risk factors associated with persistent acute otitis media at follow-up 2-3 weeks later included age <15 months (p=.014) and having a sibling with a history of recurrent otitis media (p=.036).

Additional Comments

• The goal of the study was to establish a selective follow-up strategy and potentially reduce the number of office visits required for otitis media follow-up.
• The study suggested that without post-treatment otitis media follow-up, approximately ~10% of kids with persistent otitis media would be missed, however, since 75% of cases resolve the absolute number of missed cases would be small.
• The observations made as a result of this study were done by extrapolating data from a rather small sample size (45/181) - hence broad confidence intervals.
• Selection bias was present as 95% of enrolled patients were Caucasian.
• Measurement bias was present since such a large number of children were lost to follow-up.
  

Citation

1. Hathaway TJ, Katz HP, Dershewitz RA, Marx TJ. Acute otitis media: Who needs posttreatment follow-up? Pediatrics 1994; 94:143-7.
2. Subcommitte on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113:1451-65.
   

CAT Author: Patricia L. Raimer, MD

CAT Appraisers: Alex Kemper, MD

Date appraised: April 6, 2005