ACUTE OTITIS-MEDIA IN CHILDREN WITH BRONCHIOLITIS

Objective. We investigated the prevalence and the etiology of acute ot itis media (AOM) in children with bronchiolitis to determine whether A OM in such children is due entirely or mainly to respiratory syncytial virus (RSV), in which ease routine antimicrobial treatment would not be appropriate. Methods. The study group consisted of children aged 2 to 24 months with bronchiolitis. In patients with AOM at entry, nasal washings for RSV enzyme-linked immunosorbent assay were obtained, and Gram-stained smear, bacterial culture, and reverse transcriptase polym erase chain reaction to detect the presence of RSV were performed on m iddle-ear aspirates. Patients without AOM were reevaluated at 48 to 72 hours, 8 to 10 days, and 18 to 22 days. Results. Forty-two children w ith bronchiolitis were enrolled. Sixty-two percent had AOM at entry or developed AOM within 10 days. An additional 24% had or eventually dev eloped otitis media with effusion. Only 14% remained free of both AOM and otitis media with effusion throughout the 3-week observation perio d. All patients with AOM had 1 or more bacterial pathogens isolated fr om one or both middle-ear aspirates. Of 33 middle-ear aspirates, Strep tococcus pneumoniae was isolated in 15, Haemophihus influenzae in 8, M oraxella catarrhalis in 8, and Staphylococcus aureus in 2. Two middle- ear aspirates yielded 2 pathogens each; 2 aspirates had no growth. RSV was identified in 17 (71%) of 24 patients with AOM. Conclusion. Bacte rial AOM is a complication in most children with bronchiolitis. Accord ingly, in patients with bronchiolitis and associated AOM, antimicrobia l treatment is indicated.