Acute otitis media (AOM) - Burden of disease on patient and family

Background: The burden of AOM on patients and their families is a major factor in future decisions on usage of vaccines against AOM pathogens. We conducted a prospective study to determine this burden. Materials and Methods: Patients with AOM from 3 primary health clinics (PHC) in southern Israel were enrolled if: < 3 yrs of age; no AOM in previous 7 d; no underlying major disease. Following initial interview on last 7 d, telephone inter-views were conducted every 2-3 d for an additional 21 d. At each contact, parents were asked about loss of work, PHC visits, antibiotic and OTC drug consumption and impact on qual-ity of life. Age- and neighborhood-matched controls (CONT) were also interviewed with identical schedule and questionnaire. Results: 158 children with AOM and 51 CONT were enrolled. No differences were found between groups with regard to age, sex, parent occupa-tion, size of family, housing and day care center (DCC) attendance. Before enrollment, patients had more AOM episodes, and more tympanocenteses than CONT (P< 0.01). The following differences per patient between the cases and controls were significant, P<0.01 (mean days/child month): Temp. > 38?C (2.4), vomiting (1.2), severe crying (7.2), loss of appetite (6.4), earache (4.9), and insomnia (6.2). The mean days/child months with 2 1 of
the above symptoms were 18.6 ? 11.0 in patients vs. 3.4 ? 6.5 in CONT (P< 0.01). With regard to health care service use (mean days/child month), the following differences were significant, P< 0.01: Visits to PHC (2.2), emergency room (0.3), otolaryngologist (0.4). The mean days/100 child days with regard to antibiotic use and OTC drugs were 49.3 and 18.6, respectively. The mean loss workday by parents per child month was 1.6 ? 2.7 in patients vs. 0.2 ? 0.5 in CONT (P< 0.01). Respective days of DCC absenteeism were 3.5 ? 2.5 vs. 0.9 ? 2.7 (P< 0.01). The burden of disease was significantly greater in children with recur-
rent AOM than in those with 1st episode. Conclusion: Each AOM episode significantly: re duces the quality of life of the child and and parents, increases the use of medical services and drugs, and causes work loss of parents/