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ARTICLE:
Juan C. Celedon, Augusto A. Litonjua, Scott T. Weiss, and Diane R. Gold
Day Care Attendance in the First Year of Life and Illnesses of the Upper and Lower Respiratory Tract in Children With a Familial History of Atopy
Pediatrics 1999; 104: 495-500 [Abstract] [Full text] [PDF]
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[Read P3R] Vague vagaries of AOM vs OME
s l block   (9 December 1999)

Vague vagaries of AOM vs OME 9 December 1999
Top
s l block,
peds
u of louisville

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Re: Vague vagaries of AOM vs OME

slblock{at}pol.net s l block

Your group presents a cogent, interesting and well-conceived article on day care as a risk factor for respiratory illnesses based on parental recall of assumedly treated "otitis media". This apparently would exclude OME during your study interval. However, some "ear infections" as recalled by the parents, may have been OME, and probably were not treated with antibiotics by the physician.

One faux pas that often muddies the water of "otitis media" and, I think is critical to clarify in articles regarding the incidence of "otitis media", is to distinguish between AOM and OME. You referred to the Pittsburgh data as assessing AOM.

In this article by the master, erudite Paradise et al that you referenced, the "apples and oranges" have been mixed up again. Although the article is about "otitis media", the authors used 'middle ear effusion' (ie both OME + AOM) as the reference point for all the data analysis. As their article states in the methods section, later in their cohort the treatment of "otitis media" changed:

"Originally the guidelines called for antimicrobial treatment routinely for new epsiodes of either AOM or OME,..." Later after september 1994, "antimicrobial treatment for OME is limited to instances in which persistence of effusion is prompting consideration of tymp-tube placement,..."

The horses were changed mid stream. Obviously, as these experts realized, we now for sure know that only AOM should be treated with antimicrobials. (Treatment of long term OME with antibioitics is still controversial.) Consequently, the Pittsburgh article, although alluding to AOM initially in the introduction, analyzed data for BOTH AOM + OME, otherwise termed-- days of middle ear effusion. To imply that the Pittsburgh article examined the incidence of and risk factors for AOM would be misleading, I believe.

Thus it would be most beneficial for thought leaders such as yourself, to help us in the trenches of general pediatrics by clearly stating whether the data or the references are discussing OME vs. AOM vs. both OME +AOM, if possible. The generic term of "otitis media" continues to muddy the waters of the already murky epidemiology of this disease. Truly antibiotic-treatable and -responsive disease is AOM only. best regards SLB