Is Bilateral Acute Otitis Media Clinically more Refractory than Unilateral Acute Otitis Media?

Abstract

Objective: To compare the clinical characteristics of bilateral acute otitis media (BAOM) with unilateral acute otitis media (UAOM) in children and to find risk factors of refractory otitis media.Patients and Methods: Four hundred and sixty-six children aged 0 to 14 years old (median age; 1 year old) with AOM were enrolled during January 2010 and June 2011.Diagnosis of acute otitis media, the severity classification by clinical/ontological scores, and treatments were based on Clinical Practical Guidelines for Acute Otitis Media in Children in Japan 2009. Refractory acute otitis media (RAOM) was designated as recurrent acute otitis media with more than 3 episodes in 6 months or more than 4 episodes in 12 months and/or persistent otitis media with a prolonged course of otitis media more than 3 weeks after the treatment. A multivariate logistic regression analysis was used to estimate the risk of BAOM and UAOM presenting with RAOM.Results: One hundred and thirty-seven (29.4%) patients were diagnosed as having RAOM. Two hundred and seventy-eight (60%) patients were diagnosed as having BAOM, 45.3% of whom had RAOM, whereas 11 (5.9%) of 188 patients with UAOM showed a refractory clinical course. One hundred and fifty-four (33%) patients were under 2 years of age and 71.3% of them had RAOM. The odds ratio for BAOM patients (compared with UAOM patients) to present with RAOM was 8.7 (95% confidence interval; 4.4-17.1). The odds ratio for patients under 2 years of age (compared with patients aged 2 or over) to present with RAOM was 7.1 (95% confidence interval; 4.4-11.8).Conclusions: BAOM patients and UAOM patients aged under 2 years of age were significantly associated with an intractable clinical course, and simultaneous occurrence of otitis media and an age under 2 years were apparent risk factors for refractory otitis media.