Presence of bacterial otopathogen ups risk of repeat VTI in children with acute otitis media

In children with recurrent acute otitis media (rAOM), the presence of bacterial otopathogen, particularly nontypeable H. influenzae (NTHi), in the middle ear during ventilation tube insertion (VTI) is associated with repeat surgery, according to a recent study.

“Here, we identify a modifiable microbiologic factor for repeat VTI that can be targeted to improve clinical management of rAOM,” the authors said.

The study involved an assessment of surgical records at 8 years following VTI surgery for rAOM in children 6–36 months of age. Children were grouped according to detection of bacterial otopathogen in their middle ear effusion (MEE) at the time of VTI. The authors then compared outcomes for future otorhinolaryngology surgery.

Patients across groups had comparable age, gender, pneumococcal vaccination status, antibiotic usage, day-care attendance, number of siblings and number of AOM episodes.

Sixty-three children had polymerase chain reaction (PCR) +ve MEE, of whom 58.7 percent required repeat VTI compared with 31.4 percent of the 51 children with no otopathogen detected in their MEE (odds ratio, 3.1, 95 percent confidence interval, 1.4–6.8; p=0.004).

The most prevalent otopathogen in MEE was NTHi, comprising 79 percent of all PCR +ve MEE. In addition, respiratory virus detection did not correlate with repeat VTI.

“Repeat VTI is common in children with rAOM,” the authors said. “Identifying risk factors associated with repeat surgery will improve clinical management and prevent repeat VTI.”