Is it 3 AM in your Emergency Department? Is there a febrile infant with their still-awake parents straggling in the door? Do you hear the first few bars of the “it’s just a virus” song start playing over Spotify?
This little study prospectively enrolled healthy infants at birth and followed them to their first episode of acute otitis media or 12 months of age. They were followed specifically to determine predictive clinical and epidemiological factors influencing the first diagnosis of AOM. Additionally, as they aged and during illness, nasopharyngeal swabs were taken to evaluate viral and bacterial flora.
Based on a sample of 367 infants followed for a total of 286 child-years, there were 887 presentations for viral URIs and 180 presentations for AOM –and all but two of AOMs were preceded by a URI. The median time from URI presentation to AOM diagnosis was 3 days. These authors also present a fair bit of microbiologic data regarding specific risks for URI and AOM, although these are not specifically modifiable and of lesser clinical relevance. From a modifiable environmental outlook, however, there are a few interesting tidbits tying into what we already suspected to be true: breastfeeding is good, the new PC13 vaccine is good, and daycare is a cesspool.
Overall, this would tend to support our typical advice to parents to have their children present for a recheck 48-72 hours following Emergency Department visit, particularly if there has not been clinical improvement or in the context of apparent clinical re-worsening.
“Acute Otitis Media and Other Complications of Viral Respiratory Infection”
https://www.ncbi.nlm.nih.gov/pubmed/27020793