Unspecific symptoms commonly associated with acute otitis media include rhinitis, cough, fever, sore throat, restlessness at night, irritability, loss of appetite, vomiting and diarrhoea. A study by Niemelä et al 1 compared the incidence of these symptoms in children with acute otitis media (AOM, n = 191) to those in acutely sick children without AOM (n = 163). The relative risk of AOM in relation to other symptoms was: diarrhoea 1.1 (95% CI 0.5 to 2.4), loss of appetite 1.1 (0.7 to 1.7), rhinitis with thick discharge 1.1 (0.7 to 1.8), vomiting 1.0 (0.5 to 0.9), tiredness 0.8 (0.5 to 1.2), cough 0.7 (0.5 to 1.1), conjunctivitis 0.6 (0.3 to 1.3). Fever occurred in children with AOM significantly less often than in those without AOM (RR 0.6; 95% CI 0.4 to 1.9), as did sore throat (0.4; 95% CI 0.2 to 0.8) or headache (0.3; 95% CI 0.2 to 0.6).
A study by Heikkinen and Ruuskanen 2 included 302 children younger than 4 years (mean age 2.1 years) with upper respiratory infection of whom 121 where also diagnosed as having AOM. AOM was found in 38% of the children with fever (>37.5 C) and in 47% of those without fever (p = 0.12). Similarly, statistically significant differences in the occurrence of AOM were not found in connection with rhinitis (41% vs. 26%; p = 0.21) or cough (40% vs. 39%; p = 0.89).
A study by Kontiokari et al 3 followed 857 healthy day-care children (mean age 3.7 years) for 3 months, and the symptoms of each child were compared during upper respiratory infections with and without AOM. A total of 138 children had upper respiratory infections with and without AOM. The symptom with the strongest association with AOM was earache (RR 21.3, 95% CI 7.0 to 106), but sore throat (RR 3.2, CI 1.1 to 11), night restlessness (RR 2.6, CI 1.1 to 6.9) and fever (RR 1.8, CI 1.1 to 3.2) also had significant associations.
Laine et al 4 studied 469 children, aged 6 to 35 months, with parental suspicion of AOM. A total of 237 children had AOM and 232 had respiratory tract infection without AOM. The most common reason for parental suspicion of AOM, restless sleep, was not predictive for AOM (RR 1.0, 95% CI 0.8-1.2), nor was ear-rubbing (RR 0.7, 95% CI 0.5-1.0), occurrence of fever (RR 1.2, 95% CI: 1.0-1.4), the highest mean temperature within 24 hours or the occurrences of ear-related, nonspecific, respiratory, or gastrointestinal symptoms. The duration and severity of symptoms were not predictive for AOM, either, although rhinitis lasted longer and conjunctivitis was more severe in children with AOM. The AOM severity-of-symptom scale, based solely on symptoms, was equal in children with and without AOM.
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