Acute Otitis Media and Acute Bacterial Sinusitis

• Published in: Clinical Infectious Diseases 2011-05, Vol.52 (suppl_4), p.S277-S283
• Main Author: Wald, Ellen R.
• Format: Article
• Language: English
• Subjects: Adolescent; Bacterial diseases; Bacterial Infections - diagnosis; Bacterial Infections - microbiology; Bacterial Infections - therapy; Biological and medical sciences; Child; Child, Preschool; Children; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Ent and stomatologic bacterial diseases; Human bacterial diseases; Humans; Infant; Infant, Newborn; Infectious diseases; Medical sciences; Middle ear; Nasopharynx; Non tumoral diseases; Otitis media; Otitis Media - diagnosis; Otitis Media - microbiology; Otitis Media - therapy; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Pathogens; Pediatrics; Respiratory tract infections; Sinuses; Sinusitis; Sinusitis - diagnosis; Sinusitis - microbiology; Sinusitis - therapy; Supplement; Viruses
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cir042

Acute otitis media and acute bacterial sinusitis are 2 of the most common indications for antimicrobial agents in children. Together, they are responsible for billions of dollars of health care expenditures. The pathogenesis of the 2 conditions is identical. In the majority of children with each condition, a preceding viral upper respiratory tract infection predisposes to the development of the acute bacterial complication. It has been shown that viral upper respiratory tract infection predisposes to the development of acute otitis media in 37% of cases. Currently, precise microbiologic diagnosis of acute otitis media and acute bacterial sinusitis requires performance of tympanocentesis in the former and sinus aspiration in the latter. The identification of a virus from the nasopharynx in either case does not obviate the need for antimicrobial therapy. Furthermore, nasal and nasopharyngeal swabs are not useful in predicting the results of culture of the middle ear or paranasal sinus. However, it is possible that a combination of information regarding nasopharyngeal colonization with bacteria and infection with specific viruses may inform treatment decisions in the future.