Predictive value of parent-reported symptoms in the assessment of otitis media with effusion during infancy

Abstract

Objective - To determine the predictive value of parent-reported symptoms in the assessment of otitis media with effusion (OME) during infancy. Design - Prospective longitudinal study that compared the results of questionnaire-based parental reports with the state of the middle ear assessed by otoscopy and tympanometry at 3-month intervals from birth to the age of 2 years. Setting - Outpatient Department, University Hospital Maastricht, The Netherlands. Subjects - One hundred and fifty healthy-born infants. Main outcome measures - Sensitivity, specificity, positive and negative predictive values of parent-reported ear infection, hearing loss, mouth breathing, snoring and common cold. Results - Prevalence rates showed the following ranges: OME, 39%-53%, parent-reported ear infection, 2%-20%, hearing loss 2%-7%, mouth breathing, 30%-41%, snoring, 31%-41% and common cold, 65%-81%. Common cold demonstrated the highest sensitivity (83%) with a low specificity of 36%. Hearing loss gave the highest positive predictive value (PPV) (70%) with a moderate negative predictive value (NPV) (54%). PPV increased with the number of anamnese questions answered positively. Conclusions - The diagnostic value of parent-reported ear infection, hearing loss and common cold was found to be limited. Combinations of positively-reported symptoms gives increased diagnostic validity while the absence of parent-reported symptoms does not necessarily indicate the absence of OME.