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
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