A study of risk factors for intractable otitis media and nasopharyngeal transmission of causative pathogen

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1. Risk factors for intractable otitis mediaClinical course of pediatric acute otitis media were evaluated in 368 cases (10 to 86 months olds, 200 males, 168 females) by a scoring system depending on the clinical symptoms such as otalgia, fever, and irritability / crying and tympanic membrane finding including bulging, redness and obliteration of light corn.(1) Correlation between nasopharyngeal pathogens and severity.S.pneumoniae were frequently identified in severe cases, while in non-severe cases M.catarrhalis or no pathogen were identified.(2) Risk factors for prolonged symptoms.Young ages, severity at the first visit, identification of S.pneumoniae were the risk factors for prolonged symptoms (Odds ratio : age 9.64, severity 0.28).(3) Risk factors for prolonged abnormal finding in tympanic membraneYoung ages (<2 y.o.), severity, nasopharyngeal colonization with drug resistant S.pnuemoniae were risk factors for prolonged abnormalities in tympanic membrane (Odds : age 3.68, nasopharyngeal colonization with drug resistant pathogens 1.9)(4) Risk factors for antimicrobial treatmentYoung age (<2), severe cases, and nasopharyngeal colonization with drug resistant S.pnuemoniae were risk factors for treatment failure in severe cases.(5) Risk factors for antimicrobial treatmentYoung age (<2), severe cases, and nasopharyngeal colonization were risk factors for necessity of antimicrobial treatment in non-severe cases.2. Detection of drug resistant pathogens30% of S.pneumoniae isolated from the nasopharynx had mutations in pbp genes. β-lactamase nonproducing ampicillin resistant H.influenzae (BLNAR) were isolated in about 20%.3. Nasopharyngeal transmission of causative pathogensCausative pathogens were transmitted among sibling.