Alteration of clinical picture and treatment of pediatric acute otitis media over the past two decades

The clinical picture of acute otitis media (AOM) has changed greatly over t he last few decades: serious complications have almost disappeared but more and more children suffer from recurrent middle ear infections and prolonge d silent effusion. In this retrospective study we registered all AOM attack s among children under 10 in two rural municipal areas of Finland during 12 -month-periods in 1978-79 and 1994-95. In addition to epidemiological data, the clinical picture and given treatments were recorded. Between study per iods the number of children with recurrent AOM attacks increased heavily. T he percentage of spontaneous otorrhea decreased from 6.0 to 3.3% (P = 0.01) and the proportion of afebrile patients increased from 64.0 to 73.4% (P = 0.002). In 1978-79 there were significantly more cases of diagnostic sympto ms lasting over 24 h. Prescribing penicillin-V as a primary treatment decre ased From 80.2 to 10.5% in favor of broad-spectrum antibiotics. The primary treatment with penicillin-V was associated with a decreased risk of recurr ences. Acute tympanocentesis was performed less often and the incidence of surgical treatments (adenoidectomy and/or tympanostomy tube insertion) doub led from 6.2 to 12.4% of the acute cases. Although the clinical picture of AOM has become milder, children are treated with wider spectrum antibiotics . Nevertheless, a large number of children suffer from sequelae and there i s a greater need for surgical treatments than 20 years ago. (C) 2000 Elsevi er Science Ireland Ltd. All rights reserved.