(424) Recurrent Acute Otitis Media in Children: An International Comparative Study

Introduction: The aim of this study is to compare outcomes of children diagnosed with recurrent AOM with surgical intervention in the US compared to medical intervention in Thailand, where tympanostomy tube use for AOM is uncommon.

Methods: A retrospective international comparative study was conducted to assess a Thai pediatric cohort (0-17 years) diagnosed with recurrent AOM (at least three episodes in 6 months, or four episodes in 12 months with at least one episode within the preceding 6 months) managed medically (episodic antimicrobial therapy) and a US cohort managed with TT placement. Patients were age-matched in groups of 0-2 years, 3 to 5 years, or 6 to 17 years. Number of otorrhea events necessitating oral or topical antibiotics after surgery were collected for the US cohort, and number of oral antibiotics for an AOM episode after being diagnosed with recurrent AOM was collected for the Thai cohort.

Results: There were 30 US patients with a mean age 3.7 ± 3.1 years compared to 30 Thai patients aged 3.9 ± 3.0 years (p=0.78). The US cohort experienced a mean of 1.9 ± 1.6 episodes of otorrhea with 0.9 ± 0.87 oral antibiotics prescribed, while the Thai cohort had a mean of 3.9 ± 3.0 episodes of AOM requiring oral antibiotics (p < 0.0001). However, ultimately recurrent infections resolved after a mean time of 9 months without need for intervention in the Thai cohort. The median follow-up for the US and Thai cohorts after a diagnosis of recurrent AOM or tympanostomy tube placement were 18.5 (11-25) and 19 (14-33), respectively (p=0.34)

Conclusions: In comparing US and Thai pediatric cohorts with recurrent AOM managed with TT versus those managed with medical management, we found that TT may reduce the rate of AOM episodes, and the number of oral antibiotics needed, but overall resolution in a short period of time when assessing the risks and benefits in a resource-limited setting.