The Link between Respiratory Viruses and Ear Infections

February 18, 2011

A new study finds that one out of five children with respiratory infections develop otitis media, and that antibiotics might be unnecessary.

More than 20% of young children with colds or other respiratory viral infections will develop middle ear infections of varying severity—including some mild infections that don't require antibiotics, according to a study published in The Pediatric Infectious Disease Journal.

The study shows the "full spectrum" of acute otitis media (AOM) in infants and toddlers with respiratory viruses, which can include a mild infection in one ear but severe infection in the other.

Lead author Stella U. Kalu, MD, of University of Texas Medical Branch at Galveston, and colleagues analyzed cases of AOM developing after upper respiratory viral infections—such as a cold or flu—in 294 children ages six months to three years. The study was unique because the children were enrolled before they got sick—most studies are limited to children who have already been diagnosed with AOM. This prospective research design provides a unique illustration of the natural history of AOM in the setting of viral upper respiratory infections.

Overall, 22% of the children developed AOM during the first week of a respiratory infection. The diagnosis of AOM was based on the presence of symptoms such as fever and earache, plus inflammation of the eardrum and fluid in the middle ear. Another 7% of children had inflammation of the eardrum without fluid in the middle ear.

The eardrum inflammation was rated mild in 8% of children with AOM, moderate in 59%, and severe in 35%. One hundred twenty-six children had AOM in both ears—in 54% of these cases, the severity of inflammation was different between ears.

The children were generally treated without antibiotics when possible. Of 28 children with mild AOM, 24 got better without antibiotics, four became worse, and three eventually required antibiotics.

Acute otitis media is one of the most common childhood diseases and a major reason for antibiotic prescriptions; most cases preceded by a cold or other respiratory viral infection. Physicians may see AOM at different stages of the disease; therefore, treatment recommendations may vary.

The new study provides uniquely detailed information, including the otoscopy findings, on AOM occurring in young children with respiratory viral infections, which results suggesting that about 22% of children with a cold or other respiratory infection will develop AOM. These ear infections can range from mild to severe, and may differ from one ear to the other.

"Management of AOM likely depends on stages of the infection," Kalu and colleagues wrote. Their experience suggests that many children with mild AOM can be managed without antibiotics. The authors believe their results may be useful in developing some type of clinical score to help in differentiating children who require antibiotics from those who do not. “A clinical scoring system that can help identify children who will benefit from treatment will lead to reduction in antibiotic use of AOM,” they concluded.

Source: Wolters Kluwer Health