Earache as a Symptom of Acute Otitis

A study by Niemelä et al 1 compared the occurrence of earache in children with acute otitis media (AOM) (n = 191) to that in acutely sick children without otitis (n = 163). In children with earache the relative risk of otitis was 5.4 (95% CI 3.3 - 8.9). Stroking the ear also suggested otitis (relative risk 5.0; 95% CI 2.9 - 8.6).

A study by Heikkinen and Ruuskanen 2 included 302 children (mean age 2.1 years) with a newly onset respiratory infection. Earache occurred in 88 children, of whom 73 (83%) were found to have AOM; however, 15 children (17%) had earache without otitis. On the other hand, AOM was found in 48 children (22%) out of the 214 with no earache. The sensitivity of earache in the diagnosis of AOM was 60%, specificity 92%, positive predictive value 83% and negative predictive value 78%.

In a case-control study by Uhari et al 3 (n = 394) the relative risk of earache in AOM was 6.2 (95% CI 2.8 - 13.6).

A study by Kontiokari et al 4 compared the symptoms of 138 children during an episode of AOM to the symptoms of these same children in respiratory infections without otitis. The relative risk of AOM in connection with earache was 21.3 (95% CI 7.0-106). The relative risk was greater in over two-year-olds (47.0; 95% CI 8.0 - 1819) compared with under two-year-olds (8.5; 95% CI 2.0 - 76).

In a study by Palmu et al 5 831 children were prospectively observed in a clinic setting from the age of 2 to 24 months. In patients with AOM, myringotomy with aspiration was performed, and middle ear fluid samples were cultured for bacterial pathogens. Pneumococcal AOM was associated with more severe clinical picture, characterized by fever and earache. AOM due to H. influenzae was associated with eye symptoms and findings. Accurate prediction of a bacterial cause of infection based on symptoms and signs of AOM was not possible.

Comment: The quality of evidence is upgraded by large magnitude of effect.

References

• Niemela M, Uhari M, Jounio-Ervasti K, Luotonen J, Alho OP, Vierimaa E. Lack of specific symptomatology in children with acute otitis media. Pediatr Infect Dis J 1994 Sep;13(9):765-8. [PubMed]
• Heikkinen T, Ruuskanen O. Signs and symptoms predicting acute otitis media. Arch Pediatr Adolesc Med 1995 Jan;149(1):26-9. [PubMed]
• Uhari M, Niemelä M, Hietala J. Prediction of acute otitis media with symptoms and signs. Acta Paediatr 1995 Jan;84(1):90-2. [PubMed]
• Kontiokari T, Koivunen P, Niemelä M, Pokka T, Uhari M. Symptoms of acute otitis media. Pediatr Infect Dis J 1998 Aug;17(8):676-9. [PubMed]
• Palmu AA, Herva E, Savolainen H et al. Association of clinical signs and symptoms with bacterial findings in acute otitis media. Clin Infect Dis 2004;38(2):234-42. [PubMed]