Different Clinical Entities?
Expectant management is an acceptable treatment approach for selected children with acute otitis media (AOM) and avoids overuse of antibiotics (Journal Watch Emergency Medicine Oct 20 2006). In two recent studies, researchers hypothesized that bilateral and unilateral AOM might have different clinical, demographic, and microbiologic features. Such features might assist clinicians in determining which patients are likely to benefit from antimicrobial therapy. A study from Texas included 1216 cases with clinical characteristics of AOM in children up to age 16 years; 566 underwent tympanocentesis and culture of middle ear fluid. Fifty-eight percent of the cohort had bilateral disease. Children younger than 2 years were significantly more likely to have bilateral than unilateral disease, but bilateral or unilateral disease was not associated with ethnicity, gender, history of prior AOM, fever, or day-care attendance. Age and severity of tympanic membrane inflammation were independent predi
