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. PATIENTS AND 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.
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机译：目的：急性症状用于诊断和治疗急性中耳炎（AOM）。我们研究了是否可以通过父母怀疑AOM的原因或症状的发生，持续时间和/或严重程度来预测AOM。我们还比较了有或没有AOM的儿童的分数，包括或不包括鼓膜检查。患者和方法：父母怀疑AOM的6至35个月大的儿童符合条件。在进行鼓膜检查之前，我们在结构化问卷中记录了父母怀疑AOM，症状和评分成分的原因。结果：在研究的469名儿童中，有237名患有AOM，而232名患有无AOM的呼吸道感染。父母怀疑AOM的最常见原因是躁动的睡眠，不能预测AOM（RR：1.0 [95％CI：0.8-1.2]），也不能摸耳朵（相对风险[RR]：0.7 [95％置信度]间隔（CI）：0.5-1.0]。发烧（RR：1.2 [95％CI：1.0-1.4]）的发生或24小时内的最高平均温度均不能预测AOM，也没有耳相关，非特异性，呼吸道或胃肠道症状的发生。尽管AOM儿童的鼻炎持续时间更长且结膜炎更为严重，但症状的持续时间和严重程度并不能预测AOM。 AOM患者的临床/耳科评分（中位数：4.0 vs 2.0; P = .000）和AOM总严重度指数（11.0 vs 6.0; P = .000）（包括症状和鼓膜检查）均较高。仅基于症状的AOM症状严重程度量表在有和没有AOM的儿童中均相同（6.0比6.0; P = .917）。结论：在易发中耳炎的年龄，不能通过症状的发生，持续时间或严重程度来预测AOM。同样，仅基于症状的评分不能区分有无AOM的呼吸道感染。因此，鼓膜检查在临床实践和研究环境中对AOM的诊断和严重性分类至关重要。
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