Acute otitis media : who needs posttreatment follow-up ?

Because the optimal timing for follow-up of acute otitis media (AOM) is unknown and clinicians' recommendations for timing follow-up are highly variable, a study was conducted to determine which risk factors or symptoms could predict the resolution, recurrence, or persistence of AOM after treatment completion. Three hundred four children from a general pediatric practice in a staff-model health maintenance organization, ages 6 months to 4 years diagnosed with AOM were enrolled in a prospective study of the clinical outcome of AOM at 10 to 21 days from diagnosis. Risk factors, symptoms, and parental observations were obtained by questionnaire at both the initial and follow-up visit 10 to 21 days later. At the follow-up visit, the clinical outcome of resolved AOM or persisting AOM was determined by the examining clinician. One hundred eighty-one patients returned for follow-up between 10 to 21 days; 24.9% had AOM at follow-up. Parental impression of resolved ear infection and the absence of symptoms at follow-up identified 97.1% of children with resolved AOM. Other factors associated with increased risk of AOM at follow-up were age < or = 15 months and a family history of recurrent AOM in a sibling. Because parental judgement of ear status and observation of symptoms appear to accurately identify those children with resolved AOM, a follow-up strategy is proposed in which posttreatment follow-up may be selectively offered to children whose parent(s) feels the infection has not resolved, children whose symptoms persist, or children at higher risk for AOM such as those < or = 15 months or with a family history of recurrent otitis.